A Paradigm Shift in US Breast Reconstruction: Increasing Implant Rates
A Paradigm Shift in US Breast Reconstruction: Increasing Implant Rates
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DOI：
10.1097/prs.0b013e3182729cde
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发表时间：
2013-01-01
影响因子：
3.6
通讯作者：
Matros, Evan
中科院分区：
文献类型：
--
作者：
Albornoz, Claudia R.;Bach, Peter B.;Matros, Evan
背景：尽管它在身体形象、自尊、性和生活质量方面有好处，但历史上只有不到25%的患者接受了乳房重建。在《妇女健康和癌症权利法案》通过后，研究未能证明重建率的变化。最近的一份年度报告显示，美国乳房重建模式发生了重大变化。作者的目标是评估即刻重建的比率和类型的长期趋势。方法：利用1998年至2008年全国住院患者样本数据库对立即乳房重建趋势进行了一系列横断面研究。获得了乳房切除术、乳房重建方法（自体/植入）和社会人口统计学/医院预测因素的数据。结果：即刻乳房重建率平均每年上升5%，由20.8%上升至37.8% （p < 0.01）。自体重建率没有变化。种植体的使用平均每年增加11% (p < 0.01)，在2002年之后超过自体方法成为主要的重建方式。植入物使用的最强预测因子是2002年以后的手术，双侧乳房切除术，中西部/西部地区手术的患者和医疗保险接受者。与双侧乳房切除术相比，每年增加17% (p < 0.01)，单侧乳房切除术每年减少2% （p < 0.01）。双侧乳房切除术缺损的重建率明显高于单侧（p < 0.01）。结论：在美国，即刻重建率的显著上升与种植体使用的203%的扩张密切相关。虽然植入物使用增加的原因是多因素的，但乳房切除术方式的改变，如双侧乳房切除术的使用增加，是一个重要的因素。(塑料。Reconstr。外科杂志。131:15,2013。)
Background: Despite its benefits in body image, self-esteem, sexuality, and quality of life, historically fewer than 25 percent of patients undergo immediate breast reconstruction. After passage of the Women Health and Cancer Rights Act, studies failed to demonstrate changes in reconstructive rates. A recent single-year report suggests significant shifts in U.S. breast reconstruction patterns. The authors' goal was to assess long-term trends in rates and types of immediate reconstruction.Methods: A serial cross-sectional study of immediate breast reconstruction trends was performed using the Nationwide Inpatient Sample database from 1998 to 2008. Data on mastectomies, reconstructive method (autologous/implant), and sociodemographic/hospital predictors were obtained.Results: Immediate breast reconstruction rates increased on average 5 percent per year, from 20.8 percent to 37.8 percent (p < 0.01). Autologous reconstruction rates were unchanged. Implant use increased by an average of 11 percent per year (p < 0.01), surpassing autologous methods as the leading reconstructive modality after 2002. The strongest predictors of implant use were procedures performed after 2002, bilateral mastectomies, patients operated on in Midwest/West regions, and Medicare recipients. In contrast to bilateral mastectomies, which increased by 17 percent per year (p < 0.01), unilateral mastectomies decreased by 2 percent per year (p < 0.01). Bilateral mastectomy defects had significantly higher reconstruction rates than unilateral counterparts (p < 0.01).Conclusions: The significant rise in immediate reconstruction rates in the United States correlates closely to a 203 percent expansion in implant use. Although the reason for the increase in implant use is multifactorial, changes in mastectomy patterns, such as increased use of bilateral mastectomies, are one important contributor. (Plast. Reconstr. Surg. 131: 15, 2013.)