Plotsker Ethan L, Rubenstein Robyn N, Graziano Francis D, Haglich Kathryn, Disa Joseph J, Stern Carrie S, Nelson Jonas A
Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Plast Surg (Oakv). 2024 Aug;32(3):423-431. doi: 10.1177/22925503221141708. Epub 2022 Dec 13.
Rates of direct-to-implant (DTI) breast reconstruction, in which breast implants are placed at the time of mastectomy, have been consistently rising. Advances in surgical adjuncts and technology, such as acellular dermal matrices (ADM), have made DTI reconstruction safer and more reliable. However, few studies have characterized early (30-day) postoperative complications following DTI. The aim of this study was to obtain a current understanding of early postoperative outcomes following DTI breast reconstruction. Using data from the American College of Surgeons-National Surgical Quality Improvement Program, we analyzed complications for female patients who underwent DTI reconstruction from 2017 to 2019, as well as trends in DTI reconstruction from data on mastectomy and DTI reconstruction from 2010 to 2019. We grouped complications into major surgical (including return to the operating room) or medical complications. Statistical analysis was performed using Fischer's exact test for categorical variables, Student's t-test for continuous variables, and logistic regression. DTI breast reconstruction rates have increased since 2010. Among our 2017-2019 cohort of 4204 patients, the early major surgical complication rate was approximately 10% (422 patients) and the major medical complication rate was 0.83% (35 patients). Regression modeling identified body mass index, smoking status, hypertension, bleeding disorders, and intraoperative blood transfusion as having a relationship with surgical complications ( < .001). Despite increased use of ADM and indocyanine green angiography, compared to prior studies, early postoperative complications have remained stable. Further studies are needed to assess long-term complications and patient-reported outcomes in DTI breast reconstruction.
在乳房切除术时直接植入乳房假体的直接植入式（DTI）乳房重建率一直在持续上升。手术辅助手段和技术的进步，如脱细胞真皮基质（ADM），使DTI重建更安全、更可靠。然而，很少有研究描述DTI术后早期（30天）并发症的情况。本研究的目的是了解DTI乳房重建术后早期的结果。利用美国外科医师学会-国家外科质量改进计划的数据，我们分析了2017年至2019年接受DTI重建的女性患者的并发症，以及从2010年至2019年乳房切除术和DTI重建数据中得出的DTI重建趋势。我们将并发症分为主要手术并发症（包括返回手术室）或医疗并发症。使用Fischer精确检验分析分类变量，使用学生t检验分析连续变量，并进行逻辑回归分析。自2010年以来，DTI乳房重建率有所上升。在我们2017 - 2019年的4204例患者队列中，早期主要手术并发症发生率约为10%（422例患者），主要医疗并发症发生率为0.83%（35例患者）。回归模型确定体重指数、吸烟状况、高血压、出血性疾病和术中输血与手术并发症有关（<0.001）。尽管ADM和吲哚菁绿血管造影的使用增加，但与先前的研究相比，术后早期并发症一直保持稳定。需要进一步研究来评估DTI乳房重建的长期并发症和患者报告的结果。
