背景:个体结局可能无法准确反映围手术期护理的质量。教科书结果(TOs)是综合指标,可全面评估医院绩效和手术质量。这项研究旨在调查多机构队列患者中TOs的患病率和预测因素,这些患者接受了深腹下动脉穿支皮瓣的乳房重建。
方法:对于自体重建,以前将TO定义为没有术中并发症的手术,再操作,需要静脉注射抗生素的感染,重新接纳,死亡率,全身性并发症,双侧手术持续时间≤12小时,单侧/堆叠重建手术持续时间≤10小时,住院时间(LOS)≤5天。我们使用多变量回归分析研究了患者水平因素与实现TO之间的关联。
结果:在1000名患者中,大多数(73.2%)达到了目标。偏离TO的最常见原因是再次手术(9.6%),手术时间延长(9.5%),和延长的LOS(9.2%)。在单变量分析中,烟草使用,肥胖,丧偶/离婚的婚姻状况,对侧预防性乳房切除术或双侧乳房重建术与TOs的可能性较低相关(P<0.05)。调整后,双侧预防性乳房切除术(比值比[OR],5.71;P=0.029)和激素治疗(OR,1.53;P=0.050)与较高的TOs可能性相关;较高的体重指数(OR,0.91;P=<0.001)与较低的可能性相关。
结论:大约30%的患者没有达到TO,并且实现TO的可能性受患者和手术因素的影响.未来的研究应研究该指标如何用于评估患者和医院水平的表现,以提高重建手术的护理质量。
BACKGROUND: Individual outcomes may not accurately reflect the quality of perioperative care. Textbook outcomes (TOs) are composite metrics that provide a comprehensive evaluation of hospital performance and surgical quality. This study aimed to investigate the prevalence and predictors of TOs in a multi-institutional cohort of patients who underwent breast reconstruction with deep inferior epigastric artery perforator flaps.
METHODS: For autologous reconstruction, a TO was previously defined as a procedure without intraoperative complications, reoperation, infection requiring intravenous antibiotics, readmission, mortality, systemic complications, operative duration ≤12 hours for bilateral and ≤10 hours for unilateral/stacked reconstruction, and length of stay (LOS) ≤5 days. We investigated associations between patient-level factors and achieving a TO using multivariable regression analysis.
RESULTS: Of 1000 patients, most (73.2%) met a TO. The most common reasons for deviation from a TO were reoperation (9.6%), prolonged operative time (9.5%), and prolonged LOS (9.2%). On univariate analysis, tobacco use, obesity, widowed/divorced marital status, and contralateral prophylactic mastectomy or bilateral reconstruction were associated with a lower likelihood of TOs (P < 0.05). After adjustment, bilateral prophylactic mastectomy (odds ratio [OR], 5.71; P = 0.029) and hormonal therapy (OR, 1.53; P = 0.050) were associated with a higher likelihood of TOs; higher body mass index (OR, 0.91; P = <0.001) was associated with a lower likelihood.
CONCLUSIONS: Approximately 30% of patients did not achieve a TO, and the likelihood of achieving a TO was influenced by patient and procedural factors. Future studies should investigate how this metric may be used to evaluate patient and hospital-level performance to improve the quality of care in reconstructive surgery.