National trends in immediate and delayed post-mastectomy reconstruction procedures in England: A seven-year population-based cohort study
National trends in immediate and delayed post-mastectomy reconstruction procedures in England: A seven-year population-based cohort study
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DOI：
10.1016/j.ejso.2016.09.019
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发表时间：
2017-01-01
期刊：
影响因子：
3.8
通讯作者：
Cromwell, D. A.
中科院分区：
文献类型：
--
作者：
Mennie, J. C.;Mohanna, P. -N.;Cromwell, D. A.
简介：在英国，对诊断为乳腺癌的女性的乳房切除术后重建手术趋势知之甚少。我们的目的是检查模式的即时和延迟重建程序随着时间的推移和regions.Methods：妇女与乳腺癌谁接受了单侧指数即时或延迟乳房切除术后重建2007年和2014年之间确定使用国家医院事件统计数据库。根据重建手术的类型将妇女分组。调整后的植入物和游离皮瓣重建率，然后计算跨区域癌症网络使用回归模型，以调整年龄，疾病，合并症，种族，和deprivation.Results：在2007年和2014年之间，21 862名妇女进行了立即重建和8653延迟重建。即刻种植体重建从30%增加到54%，即刻游离皮瓣重建从17%增加到21%。调整后的即刻种植和游离皮瓣比例在各地区分别为17 - 68%和9- 63%。游离皮瓣在延迟安置中变得更常见，从25%上升到42%。然而，各区域的调整后比率从23%到74%不等。网络与高/低利率的自由皮瓣立即倾向于有高/低利率延迟reconstruction.Conclusion：有一个显着增加立即种植重建在英格兰的使用。相比之下，自体游离皮瓣重建在延迟手术中的应用越来越多。重大的区域差异存在的类型进行重建，这些模式需要进行检查，以确定是否与服务的提供和/或容量沐浴变化。(C)2016 Elsevier Ltd，BASO类似于癌症外科协会和欧洲外科肿瘤学会。All rights reserved.
Introduction: Little is known about post-mastectomy reconstruction procedural trends in women diagnosed with breast cancer in England. Our aim was to examine patterns of immediate and delayed reconstruction procedures over time and within regions.Methods: Women with breast cancer who underwent unilateral index immediate or delayed post-mastectomy reconstruction between 2007 and 2014 were identified using the National Hospital Episode Statistics database. Women were grouped into categories based on the type of reconstruction procedure. Adjusted rates of implant and free flap reconstructions were then calculated across regional Cancer Networks using a regression model to adjust for age, disease, comorbidities, ethnicity, and deprivation.Results: Between 2007 and 2014, 21 862 women underwent immediate reconstruction and 8653 delayed reconstruction. Immediate implant reconstruction increased from 30% to 54%, and immediate free flap reconstruction from 17% to 21%. Adjusted immediate implant and free flap proportions ranged from 17 to 68% and 9-63%, respectively, across regions. Free flaps became more common in the delayed setting, rising from 25% to 42%. However, adjusted rates ranged from 23% to 74% across regions. Networks with high/low rates of free flaps for immediate tended to have high/low rates for delayed reconstruction.Conclusion: There has been a substantial increase in the use of immediate implant reconstruction in England. In comparison, there has been an increasing use of autologous free flap reconstruction for delayed procedures. Significant regional variation exists in the type of reconstruction performed, and these patterns need to be examined to determine if variation is related to service provision and/or capacity bathers. (C) 2016 Elsevier Ltd, BASO similar to The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.