Individualized Risk of Surgical Complications: An Application of the Breast Reconstruction Risk Assessment Score
Individualized Risk of Surgical Complications: An Application of the Breast Reconstruction Risk Assessment Score
复制标题
DOI：
10.1097/gox.0000000000000351
复制
发表时间：
2015-05-01
影响因子：
1.5
通讯作者：
Gutowski, Karol A.
中科院分区：
文献类型：
--
作者：
Kim, John Y. S.;Mlodinow, Alexei S.;Gutowski, Karol A.
背景：风险讨论是外科医生与患者对话的中心原则。风险计算器最近提供了一种新的方法，将循证实践整合到个性化患者风险和预期管理的讨论中。以整形外科医生综合追踪手术和结果数据库(TOPS)为中心，努力将整形手术结果添加到先前开发的乳房重建风险评估(BRA)评分中。结果：11,992例患者中，4439例符合纳入标准。术后并发症发生率为15.9%，其中浆液性病变3.4%，SSI 4.0%，裂开6.1%，植入术3.7%，皮瓣丢失7.0%，再次手术6.4%。个性化风险模型的开发具有可接受的拟合度、准确性和内部效度。总体并发症风险的分布是广泛和不对称的，这意味着对于任何给定的患者来说，平均风险往往是对风险的糟糕估计。这些模型被添加到之前开发的开放获取版本的风险计算器中，该计算器可在http://www.BRAscore.org.Conclusions：获得，基于人群的风险测量可能无法准确反映许多单个患者的风险。在这个日益重视循证医学的时代，我们从稳健的TOPS数据库开发了乳房重建风险评估计算器。胸罩评分工具可以帮助个性化-和量化-风险，以更好地为手术决策提供信息，并更好地管理患者的期望。
Background: Risk discussion is a central tenet of the dialogue between surgeon and patient. Risk calculators have recently offered a new way to integrate evidence-based practice into the discussion of individualized patient risk and expectation management. Focusing on the comprehensive Tracking Operations and Outcomes for Plastic Surgeons (TOPS) database, we endeavored to add plastic surgical outcomes to the previously developed Breast Reconstruction Risk Assessment (BRA) score.Methods: The TOPS database from 2008 to 2011 was queried for patients undergoing breast reconstruction. Regression models were constructed for the following complications: seroma, dehiscence, surgical site infection (SSI), explantation, flap failure, reoperation, and overall complications.Results: Of 11,992 cases, 4439 met inclusion criteria. Overall complication rate was 15.9%, with rates of 3.4% for seroma, 4.0% for SSI, 6.1% for dehiscence, 3.7% for explantation, 7.0% for flap loss, and 6.4% for reoperation. Individualized risk models were developed with acceptable goodness of fit, accuracy, and internal validity. Distribution of overall complication risk was broad and asymmetric, meaning that the average risk was often a poor estimate of the risk for any given patient. These models were added to the previously developed open-access version of the risk calculator, available at http://www.BRAscore.org.Conclusions: Population-based measures of risk may not accurately reflect risk for many individual patients. In this era of increasing emphasis on evidence-based medicine, we have developed a breast reconstruction risk assessment calculator from the robust TOPS database. The BRA Score tool can aid in individualizing-and quantifying-risk to better inform surgical decision making and better manage patient expectations.