Trending Towards Safer Breast Cancer Surgeries? Examining Acute Complication Rates from A 13-Year NSQIP Analysis
Trending Towards Safer Breast Cancer Surgeries? Examining Acute Complication Rates from A 13-Year NSQIP Analysis
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DOI：
10.3390/cancers11020253
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发表时间：
2019-02-01
期刊：
影响因子：
5.2
通讯作者：
Chatterjee, Abhishek
中科院分区：
文献类型：
--
作者：
Jonczyk, Michael M.;Jean, Jolie;Chatterjee, Abhishek
随着乳腺癌手术的不断发展，本研究强调了部分乳房切除术（PM）、乳房切除术（M）、乳房切除术伴肌瓣重建（M + MF）、乳房切除术伴植入体重建（M + I）和肿瘤整形手术（OPS）后的急性并发症发生率和诱发风险。数据来自美国外科医生学会NSQIP数据库（2005-2017）。并发症发生率和趋势分析进行了沿着与使用调整的线性回归的易感风险因素的比值比的评估。226，899例患者符合入选标准。所有乳房切除术组的并发症发生率稳步上升（p < 0.05）。不同手术类别的累积并发症发生率在每个并发症群中均存在显著差异（所有p < 0.0001）。总体并发症发生率为：PM：2.25%，OPS：3.2%，M：6.56%，M + MF：13.04%和M + I：5.68%。最常见的预测风险因素是乳房切除术、手术时间延长、阿萨分级、BMI、吸烟、近期体重减轻、CHF、COPD和出血性疾病病史（所有p < 0.001）。非糖尿病患者、年轻患者（年龄< 60岁）和门诊治疗的患者均具有急性并发症的保护性OR（p < 0.0001）。这项研究提供了比较不同乳腺癌手术后全国范围内急性并发症发生率的数据。这些可以用于在手术决策过程中告知患者。
As breast cancer surgery continues to evolve, this study highlights the acute complication rates and predisposing risks following partial mastectomy (PM), mastectomy(M), mastectomy with muscular flap reconstruction (M + MF), mastectomy with implant reconstruction (M + I), and oncoplastic surgery (OPS). Data was collected from the American College of Surgeons NSQIP database (2005-2017). Complication rate and trend analyses were performed along with an assessment of odds ratios for predisposing risk factors using adjusted linear regression. 226,899 patients met the inclusion criteria. Complication rates have steadily increased in all mastectomy groups (p < 0.05). Cumulative complication rates between surgical categories were significantly different in each complication cluster (all p < 0.0001). Overall complication rates were: PM: 2.25%, OPS: 3.2%, M: 6.56%, M + MF: 13.04% and M + I: 5.68%. The most common predictive risk factors were mastectomy, increasing operative time, ASA class, BMI, smoking, recent weight loss, history of CHF, COPD and bleeding disorders (all p < 0.001). Patients who were non-diabetic, younger (age < 60) and treated as an outpatient all had protective OR for an acute complication (p < 0.0001). This study provides data comparing nationwide acute complication rates following different breast cancer surgeries. These can be used to inform patients during surgical decision making.