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Abstract：
OBJECTIVE: The aim of this study was to compare postoperative outcomes between biologic and synthetic reconstructions after chest wall resection in a matched cohort.
METHODS: All patients who underwent reconstruction after full-thickness chest wall resection from 2000 to 2022 were reviewed and stratified by prosthesis type (biologic or synthetic). Biologic prostheses were of biologic origin or were fully absorbable and incorporable. Integer matching was performed to reduce confounding. The study end point was surgical site complications requiring reoperation. Multivariable analysis was performed to identify associated risk factors.
RESULTS: In total, 438 patients underwent prosthetic chest wall reconstruction (unmatched: biologic, n = 49; synthetic, n = 389; matched: biologic, n = 46; synthetic, n = 46). After matching, the median (interquartile range) defect size was 83 cm2 (50-142) for the biologic group and 90 cm2 (48-146) for the synthetic group (P = 0.97). Myocutaneous flaps were used in 33% of biologic reconstructions (n = 15) and 33% of synthetic reconstructions (n = 15) in the matched cohort (P = 0.99). The incidence of surgical site complications requiring reoperation was not significantly different between biologic and synthetic reconstructions in the unmatched (3 [6%] vs 29 [7%]; P = 0.99) and matched (2 [4%] vs 4 [9%]; P = 0.68) cohorts. On the multivariable analysis, operative time [adjusted odds ratio (aOR) = 1.01, 95% confidence interval (CI), 1.00-1.01; P = 0.006] and operative blood loss (aOR = 1.00, 95% CI, 1.00-1.00]; P = 0.012) were associated with higher rates of surgical site complications requiring reoperation; microvascular free flaps (aOR = 0.03, 95% CI, 0.00-0.42; P = 0.024) were associated with lower rates.
CONCLUSIONS: The incidence of surgical site complications requiring reoperation was not significantly different between biologic and synthetic prostheses in chest wall reconstructions.
METHODS: All patients who underwent reconstruction after full-thickness chest wall resection from 2000 to 2022 were reviewed and stratified by prosthesis type (biologic or synthetic). Biologic prostheses were of biologic origin or were fully absorbable and incorporable. Integer matching was performed to reduce confounding. The study end point was surgical site complications requiring reoperation. Multivariable analysis was performed to identify associated risk factors.
RESULTS: In total, 438 patients underwent prosthetic chest wall reconstruction (unmatched: biologic, n = 49; synthetic, n = 389; matched: biologic, n = 46; synthetic, n = 46). After matching, the median (interquartile range) defect size was 83 cm2 (50-142) for the biologic group and 90 cm2 (48-146) for the synthetic group (P = 0.97). Myocutaneous flaps were used in 33% of biologic reconstructions (n = 15) and 33% of synthetic reconstructions (n = 15) in the matched cohort (P = 0.99). The incidence of surgical site complications requiring reoperation was not significantly different between biologic and synthetic reconstructions in the unmatched (3 [6%] vs 29 [7%]; P = 0.99) and matched (2 [4%] vs 4 [9%]; P = 0.68) cohorts. On the multivariable analysis, operative time [adjusted odds ratio (aOR) = 1.01, 95% confidence interval (CI), 1.00-1.01; P = 0.006] and operative blood loss (aOR = 1.00, 95% CI, 1.00-1.00]; P = 0.012) were associated with higher rates of surgical site complications requiring reoperation; microvascular free flaps (aOR = 0.03, 95% CI, 0.00-0.42; P = 0.024) were associated with lower rates.
CONCLUSIONS: The incidence of surgical site complications requiring reoperation was not significantly different between biologic and synthetic prostheses in chest wall reconstructions.
摘要：
目的：比较胸壁切除术后生物重建和合成重建的结果。
方法：对2000年至2022年进行全厚度胸壁切除术后进行重建的所有患者进行审查，并按假体类型（生物型或合成型）进行分层。生物假体是生物起源的，或者是完全可吸收和可结合的。进行整数匹配以减少混杂。研究终点是需要再次手术的手术部位并发症。进行多变量分析以确定相关的危险因素。
结果：总计，438例患者接受了假体胸壁重建（无与伦比：生物学，n=49；合成，n=389；匹配：生物，n=46；合成，n=46）。匹配后,生物组的中位缺损尺寸(四分位距)为83cm2(50-142),合成组为90cm2(48-146)(P=0.97).在匹配的队列中，33％的生物重建（n=15）和33％的合成重建（n=15）使用了肌皮瓣（P=0.99）。需要再次手术的手术部位并发症的发生率在无与伦比的生物重建和合成重建之间没有显着差异（3[6％]与29[7%]；P=0.99）和匹配（2[4%]与4[9%]；P=0.68）队列。在多变量分析中，手术时间(比值比[OR]=1.01，95%置信区间[CI]，1.00-1.01；P=0.006）和手术失血量（OR=1.00，95％CI，1.00-1.00]；P=0.012与需要再次手术的手术部位并发症发生率较高相关；微血管游离皮瓣（OR=0.03，95％CI，0.00-0.42；P=0.024）与较低的发生率相关。
结论：需要再次手术的手术部位并发症的发生率在胸壁重建中生物假体和合成假体之间没有显著差异。
方法：对2000年至2022年进行全厚度胸壁切除术后进行重建的所有患者进行审查，并按假体类型（生物型或合成型）进行分层。生物假体是生物起源的，或者是完全可吸收和可结合的。进行整数匹配以减少混杂。研究终点是需要再次手术的手术部位并发症。进行多变量分析以确定相关的危险因素。
结果：总计，438例患者接受了假体胸壁重建（无与伦比：生物学，n=49；合成，n=389；匹配：生物，n=46；合成，n=46）。匹配后,生物组的中位缺损尺寸(四分位距)为83cm2(50-142),合成组为90cm2(48-146)(P=0.97).在匹配的队列中，33％的生物重建（n=15）和33％的合成重建（n=15）使用了肌皮瓣（P=0.99）。需要再次手术的手术部位并发症的发生率在无与伦比的生物重建和合成重建之间没有显着差异（3[6％]与29[7%]；P=0.99）和匹配（2[4%]与4[9%]；P=0.68）队列。在多变量分析中，手术时间(比值比[OR]=1.01，95%置信区间[CI]，1.00-1.01；P=0.006）和手术失血量（OR=1.00，95％CI，1.00-1.00]；P=0.012与需要再次手术的手术部位并发症发生率较高相关；微血管游离皮瓣（OR=0.03，95％CI，0.00-0.42；P=0.024）与较低的发生率相关。
结论：需要再次手术的手术部位并发症的发生率在胸壁重建中生物假体和合成假体之间没有显著差异。
