Naaseh Ariana, Bewley Alice F, Nickel Katelin B, Myckatyn Terence M, Margenthaler Julie A
Section of Surgical Oncology, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA.
Division of Public Health Sciences, Washington University School of Medicine, St. Louis, MO, USA.
Ann Surg Oncol. 2025 Sep 10. doi: 10.1245/s10434-025-18283-9.
Postmastectomy autologous reconstruction (PMAR) is an important component of comprehensive breast cancer care. Previous research has suggested the existence of sociodemographic disparities in complications after immediate PMAR. The objective of this study was to examine the impact of sociodemographic and clinical factors on immediate PMAR postoperative outcomes.
We performed a retrospective cohort study of adult patients undergoing PMAR in the Healthcare Cost and Utilization Project Florida State Inpatient Database (2016-2021). Postmastectomy autologous reconstruction included deep inferior epigastric perforator (DIEP), transverse rectus abdominis myocutaneous (TRAM), and latissimus dorsi (LD) flaps. Primary outcomes were inpatient postoperative complications and readmissions within 30 and 90 days. Data elements were abstracted by using ICD-10 codes and comorbidities defined by using the Elixhauser classification. Univariate and multivariate analyses were performed.
We identified 3537 women admitted for PMAR. 483 (13.7%) patients experienced complications 30 days postsurgery. An additional 46 patients (15%) experienced complications within 90 days. A total of 224 patients (6.3%) were readmitted within 30 days, and 368 (10.4%) were readmitted within 90 days. Patients living in smaller metropolitan areas or with four or more comorbidities had significantly increased odds of complications. Patients with Medicaid, Medicare, or two or more comorbidities were significantly more likely to experience hospital length of stay ≥7 days. Residing in smaller metropolitan areas, having two or more comorbidities, or having Medicare were associated with increased odds of 30-day and 90-day readmission.
Disparities exist in outcomes after PMAR in patients with public insurance, residing in smaller metropolitan areas, and with multiple comorbidities. These findings should be further evaluated to assess validity and determine generalizability.
乳房切除术后自体组织重建（PMAR）是综合乳腺癌治疗的重要组成部分。先前的研究表明，即时PMAR术后并发症存在社会人口统计学差异。本研究的目的是探讨社会人口统计学和临床因素对即时PMAR术后结局的影响。
我们在医疗成本与利用项目佛罗里达州住院数据库（2016 - 2021年）中对接受PMAR的成年患者进行了一项回顾性队列研究。乳房切除术后自体组织重建包括腹壁下深动脉穿支（DIEP）皮瓣、腹直肌肌皮瓣（TRAM）和背阔肌（LD）皮瓣。主要结局是术后30天和90天内的住院并发症和再入院情况。数据元素通过使用国际疾病分类第十版（ICD - 10）编码提取，并使用埃利克斯豪泽分类法定义合并症。进行了单因素和多因素分析。
我们确定了3537名因PMAR入院的女性。483名（13.7%）患者在术后30天出现并发症。另有46名患者（15%）在90天内出现并发症。共有224名患者（6.3%）在30天内再次入院，368名（10.4%）在90天内再次入院。居住在较小都市地区或有四种或更多合并症的患者出现并发症的几率显著增加。有医疗补助、医疗保险或两种或更多合并症的患者住院时间≥7天的可能性显著更高。居住在较小都市地区、有两种或更多合并症或有医疗保险与30天和90天再入院几率增加相关。
在有公共保险、居住在较小都市地区且有多种合并症的患者中，PMAR术后结局存在差异。这些发现应进一步评估以评估其有效性并确定可推广性。
