背景:成功的游离皮瓣重建手术与医院容量之间的关联尚未明确。本研究旨在回顾性分析在日本全国外科注册系统中注册的游离皮瓣手术的结果,以阐明游离皮瓣存活与设施之间的关系。
方法:我们分析了2017-2020年期间在日本407家工厂进行的19,482次游离皮瓣的数据。在适应性爱之后,年龄,和疾病分类不同,我们根据每年进行的平均游离皮瓣手术次数,研究了不同设施之间皮瓣存活率的差异。
结果:总坏死率为2.8%。在所有程序中,14.9%,12.9%,33.4%,38.8%的患者在每年平均自由皮瓣手术次数<10、10-19、20-49和≥50的设施中进行,分别,总坏死率分别为6.0%,3.8%,2.1%,和1.7%,分别。每年≥50例的设施相对于<10例的设施,皮瓣坏死的比值比和95%置信区间为非乳房重建病例为2.70(1.98-3.68),乳房重建病例为5.72(2.77-11.8)。
结论:这项对全国整形外科数据库的分析显示,在每年平均游离皮瓣手术数量较低的机构中,游离皮瓣手术发生总坏死的风险较高。应采取措施将案件汇总到高容量中心或改善低容量中心的管理。
The association between successful reconstructive surgery with a free flap and hospital volume has not been well established. This
study was designed to retrospectively analyze the outcome of free-flap surgery registered in a nationwide surgical registration system in Japan to clarify the relationship between free-flap survival and facilities\' average annual number of free-flap surgeries.
We analyzed data from 19,482 free flaps performed during 2017-2020 at 407 facilities throughout Japan. After adjusting for sex, age, and disease classification that differ between the groups, we examined the differences in the flap survival rates among the different facilities in terms of the average number of free-flap surgeries performed annually.
The total overall necrosis rate was 2.8%. Of all procedures, 14.9%, 12.9%, 33.4%, and 38.8% were performed at facilities with an average number of free-flap procedures <10, 10-19, 20-49, and ≥ 50 per year, respectively, and the respective rates of total necrosis were 6.0%, 3.8%, 2.1%, and 1.7%, respectively. The odds ratios and 95% confidence intervals of flap necrosis for facilities with ≥ 50 cases per year relative to those <10 were 2.70 (1.98-3.68) for nonbreast reconstruction cases and 5.72 (2.77-11.8) for breast reconstruction cases.
This analysis of a nationwide plastic surgery database showed that free-flap surgeries in institutions with a low average annual number of free-flap surgeries had a higher risk of total necrosis. Measures should be taken to either aggregate cases into high-volume centers or improve management at low-volume centers.