背景:早期假体丢失是乳房再造后罕见但严重的并发症。我们使用ACS-NSQIP数据集评估了与立即乳房重建(IBR)后早期设备丢失相关的围手术期风险因素。
方法:我们回顾了2005年至2011年ACS-NSQIP数据库,用于识别CPT代码19357和19340的遭遇。根据标准数据集变量,患者被确定为经历“移植物/假体丢失”。在围手术期特征方面,将发生设备丢失的患者与未发生设备丢失的患者进行比较。
结果:我们确定了14,585名患者,平均年龄为50.9±10.6岁。多元回归分析确定年龄(>55岁)(比值比[OR]1.66,p=0.013)(风险评分=1),II级肥胖(OR3.17,p<0.001)(风险评分=3),III级肥胖(OR2.41,p=0.014)(风险评分=3),主动吸烟(OR2.95,p<0.001)(风险评分=3),双侧重建(OR1.67,p=0.007)(风险评分=1),和直接植入(DTI)重建(OR1.69,p=0.024)(风险评分=1)与早期器械丢失相关.赔率比用于为每位患者分配加权风险评分,风险类别分为低风险(0到1,n=9,349),中等风险(2至5,n=5,001),和高危(≥6,n=233)组。随着风险评分的增加,设备丢失的风险明显更高(0.39%vs1.48%vs3.86%,p<0.001)。
结论:IBR后早期器械丢失是一个复杂的多因素过程,与可识别的术前危险因素有关。这项研究表明,年龄,肥胖,吸烟,双边程序,和DTI重建与植入物丢失风险增加相关。
BACKGROUND: Early prosthesis loss is an infrequent but serious complication after breast reconstruction. We assessed perioperative risk factors associated with early device loss after immediate breast reconstruction (IBR) using the ACS-NSQIP datasets.
METHODS: We reviewed the 2005 to 2011 ACS-NSQIP databases identifying encounters for CPT codes 19357 and 19340. Patients were identified as experiencing a \"loss of graft/prosthetic\" based on a standard dataset variable. Patients who experienced a device loss were compared with those who did not with respect to perioperative characteristics.
RESULTS: We identified 14,585 patients with an average age of 50.9 ± 10.6 years. A multivariate regression analysis determined that age (>55 years) (odds ratio [OR] 1.66, p = 0.013) (risk score = 1), class II obesity (OR 3.17, p < 0.001) (risk score = 3), class III obesity (OR 2.41, p = 0.014) (risk score = 3), active smoking (OR 2.95, p < 0.001) (risk score = 3), bilateral reconstruction (OR 1.67, p = 0.007) (risk score = 1), and direct-to-implant (DTI) reconstruction (OR 1.69, p = 0.024) (risk score = 1) were associated with early device loss. Odds ratios were used to assign weighted risk scores to each patient, and risk categories were broken into low risk (0 to 1, n = 9,349), intermediate risk (2 to 5, n = 5,001), and high risk (≥ 6, n = 233) groups. The risk of device loss was significantly higher with increased risk score (0.39% vs 1.48% vs 3.86%, p < 0.001).
CONCLUSIONS: Early device loss following IBR is a complex multifactorial process related to identifiable preoperative risk factors. This study demonstrated that age, obesity, smoking, bilateral procedures, and DTI reconstructions are associated with increased risk of implant loss.