Knoedler Samuel, Knoedler Leonard, Boroumand Sam, Alfertshofer Michael, Diatta Fortunay, Sofo Giuseppe, Huelsboemer Lioba, Hansen Frederik J, Könneker Sören, Kim Bong-Sung, Perozzo Filippo A G, Ayyala Haripriya, Allam Omar, Pomahac Bohdan, Kauke-Navarro Martin
Division of Plastic Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT, USA.
Division of Hand, Plastic and Aesthetic Surgery, Ludwig-Maximilians-University, Munich, Germany.
Aesthetic Plast Surg. 2025 Jan;49(2):516-527. doi: 10.1007/s00266-024-04203-x. Epub 2024 Jun 26.
BACKGROUND: Capsular contracture (CC) is a common complication following implant-based breast surgery, often requiring surgical intervention. Yet, little is known about risk factors and outcomes following CC surgery. METHODS: We reviewed the American College of Surgeons National Surgical Quality Improvement Program database (2008-2021) to identify female patients diagnosed with CC and treated surgically. Outcomes of interest included the incidence of surgical and medical complications at 30-days, reoperations, and readmissions. Confounder-adjusted multivariable analyses were performed to establish risk factors. RESULTS: 5,057 patients with CC were identified (mean age: 55 ± 12 years and mean body mass index [BMI]: 26 ± 6 kg/m). While 2,841 (65%) women underwent capsulectomy, capsulotomy was performed in 742 patients (15%). Implant removal and replacement were recorded in 1,160 (23%) and 315 (6.2%) cases, respectively. 319 (6.3%) patients experienced postoperative complications, with 155 (3.1%) reoperations and 99 (2.0%) readmissions. While surgical adverse events were recorded in 139 (2.7%) cases, 86 (1.7%) medical complications occurred during the 30 day follow-up. In multivariate analyses, increased BMI (OR: 1.04; p = 0.009), preoperative diagnosis of hypertension (OR: 1.48; p = 0.004), and inpatient setting (OR: 4.15; p < 0.001) were identified as risk factors of complication occurrence. CONCLUSION: Based on 14 years of multi-institutional data, we calculated a net 30 day complication rate of 6.3% after the surgical treatment of CC. We identified higher BMI, hypertension, and inpatient setting as independent risk factors of postoperative complications. Plastic surgeons may wish to integrate these findings into their perioperative workflows, thus optimizing patient counseling and determining candidates' eligibility for CC surgery. LEVEL OF EVIDENCE III: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
背景：包膜挛缩（CC）是基于植入物的乳房手术后常见的并发症，通常需要手术干预。然而，对于CC手术后的危险因素和结果知之甚少。 方法：我们回顾了美国外科医师学会国家外科质量改进计划数据库（2008 - 2021年），以确定诊断为CC并接受手术治疗的女性患者。感兴趣的结果包括30天内手术和医疗并发症的发生率、再次手术和再次入院情况。进行了混杂因素调整的多变量分析以确定危险因素。 结果：共识别出5057例CC患者（平均年龄：55±12岁，平均体重指数[BMI]：26±6kg/m²）。2841例（65%）女性接受了包膜切除术，742例（15%）患者进行了包膜切开术。分别有1160例（23%）和315例（6.2%）记录了植入物取出和更换情况。319例（6.3%）患者出现术后并发症，其中155例（3.1%）再次手术，99例（2.0%）再次入院。139例（2.7%）记录了手术不良事件，30天随访期间发生86例（1.7%）医疗并发症。在多变量分析中，BMI升高（比值比：1.04；p = 0.009）、术前诊断为高血压（比值比：1.48；p = 0.004）和住院环境（比值比：4.15；p < 0.001）被确定为并发症发生的危险因素。 结论：基于14年的多机构数据，我们计算出CC手术治疗后30天的净并发症发生率为6.3%。我们确定较高的BMI、高血压和住院环境是术后并发症的独立危险因素。整形外科医生可能希望将这些发现纳入其围手术期工作流程，从而优化患者咨询并确定CC手术候选人的资格。 证据水平III：本刊要求作者为每篇文章指定证据水平。有关这些循证医学评级的完整描述，请参阅目录或在线作者指南www.springer.com/00266 。
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