Patient determinants as independent risk factors for postoperative complications of breast reconstruction
Patient determinants as independent risk factors for postoperative complications of breast reconstruction
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DOI：
10.21037/gs.2017.04.04
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发表时间：
2017-08-01
期刊：
影响因子：
1.8
通讯作者：
Mark, Hans
中科院分区：
文献类型：
--
作者：
Thorarinsson, Andri;Frojd, Victoria;Mark, Hans
背景：乳房重建是乳腺癌治疗的重要组成部分。乳房重建术后并发症很常见，影响患者满意度。利用患者特征确定独立危险因素可能有利于患者评估和咨询。 方法：在本研究中，我们回顾性地纳入了 623 名连续接受深下腹壁穿支皮瓣 (DIEP)、背阔肌皮瓣 (LD)、外侧胸背皮瓣 (LTDF) 或带有二次植入物的组织扩张器 (EXP) 重建的患者。收集人口统计和围手术期因素的信息，以及所有术后并发症的信息。使用Logistic回归分析可能的患者相关危险因素与术后并发症之间的关联。结果：吸烟与早期总体并发症数量最多[比值比（OR）2.05，95%置信区间（CI）1.25-3.37，P=0.0005]，其次是体重指数（BMI）（OR 1.07，95% CI 1.01-1.13， P=0.017）。高BMI与最高数量的晚期总体术后并发症相关（OR 1.06，95% CI 1.00-1.11，P=0.042），其次是放疗史（OR 1.66，95% CI 1.01-2.74，P=0.046）。当这些危险因素结合在一起时，术后并发症的风险呈指数级上升。结论：我们的研究结果提供了证据，表明患者在进行乳房再造之前应戒烟，超重患者应减肥。此外，如果患者接受过放射治疗，则应谨慎选择重建方法。高BMI、放疗史和吸烟是乳房重建手术中多种早期和晚期术后并发症的独立危险因素。这些危险因素结合起来会增加术后并发症的风险。
Background: Breast reconstruction is an essential component in the treatment of breast cancer. Postoperative complications after breast reconstruction are common and affect patient satisfaction. Determining independent risk factors using patient characteristics could be advantageous for patient assessment and counseling.Methods: We retrospectively enrolled 623 consecutive patients who underwent reconstruction with a deep inferior epigastric perforator flap (DIEP), latissimus dorsi flap (LD), lateral thoracodorsal flap (LTDF), or tissue expander with a secondary implant (EXP) in this study. Information on demographic and perioperative factors was collected, as well as information on all postoperative complications. Logistic regression was used to analyze associations between possible patient-related risk factors and postoperative complications.Results: Smoking was associated with the highest number of early overall complications [odds ratio (OR) 2.05, 95% confidence interval (CI) 1.25-3.37, P=0.0005], followed by body mass index (BMI) (OR 1.07, 95% CI 1.01-1.13, P=0.017). High BMI was associated with the highest number of late overall postoperative complications (OR 1.06, 95% CI 1.00-1.11, P=0.042), followed by history of radiotherapy (OR 1.66, 95% CI 1.01-2.74, P=0.046). When the risk factors were combined, the risk for postoperative complications rose exponentially.Conclusions: Our results provide evidence that patients should cease smoking and overweight patients should lose weight before undergoing breast reconstruction. Additionally, if the patient has received radiotherapy, the reconstruction method should be carefully chosen. High BMI, history of radiotherapy, and smoking are independent risk factors for many types of both early and late postoperative complications in breast reconstructive surgery. Combining these risk factors multiplies the risk of postoperative complications.