IMMEDIATE VS DELAYED RECONSTRUCTION AND BREAST CANCER SURGERY COMPLICATIONS

立即重建与延迟重建以及乳腺癌手术并发症

• 批准号: 8011351
• 负责人: MARGARET A OLSEN
• 金额: $ 28.81万
• 依托单位: WASHINGTON UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-02-01 至 2015-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8011351
• 关键词: Accounting; Adjuvant Radiotherapy; Algorithms; Autologous; Axillary Lymph Node Dissection; Body Image; Breast; Cancer Patient; Carcinoma in Situ; Caring; Clinical; Complication; Data; Diabetes Mellitus; Diagnosis; Emotional; Healed; Health Insurance; Hematoma; Implant; Incidence; Individual; Infection; Institution; Insurance; Internal Breast Prosthesis; Link; Malignant Neoplasms; Mammaplasty; Mastectomy; Methods; Modeling; Multicenter Studies; Nature; Necrosis; Newly Diagnosed; Obesity; Operative Surgical Procedures; Outcome; Patient Preferences; Population; Primary Neoplasm; Procedures; Process; Quality of life; Radiation therapy; Reconstructive Surgical Procedures; Recording of previous events; Relative (related person); Reporting; Risk; Risk Factors; Seroma; Site; Staging; Stratification; Surgeon; Surgical Flaps; System; Time; Tissue Expanders; Tissues; Variant; Woman; base; breast surgery; cancer surgery; case finding; comparative; healing; improved; indexing; malignant breast neoplasm; operation; population based; psychosocial; public health relevance; randomized trial; reconstruction; tumor; wound

DESCRIPTION (provided by applicant): During their lifetime, one in every eight U.S. women will be diagnosed with breast cancer, with 182,500 newly cases in 2008. Over 57,000 breast reconstruction operations are performed in the U.S. annually. Breast reconstruction can be performed immediately after mastectomy or delayed months to years later. 60% of the reconstructions in the U.S. involve tissue expanders followed by exchange for a permanent implant. Autologous flap breast reconstruction is much less common . There are no randomized trials to determine the comparative effectivess of immediate vs. delayed breast reconstruction. Decisions about the type and timing of reconstruction are based on individual surgeon and patient preference. Breast reconstruction complication rates and outcomes have been reported primarily from small studies, and almost exclusively from single institutions. Comprehensive multicenter studies to determine rates of surgical site infection and other wound complications after immediate vs. delayed reconstruction have not been performed. In single-center studies, surgical site infection rates are signficantly higher after immediate reconstruction compared to mastectomy only. In cases with an implant, 2/3 of infected implants are lost. We propose to use geographically diverse longitudinal claims data from the largest commercially insured population in the U.S. to determine the incidence of surgical site infection and noninfectious wound complications after mastectomy and immediate vs. delayed reconstruction. We will determine factors associated with risk of infectious and noninfectious wound complications in women who had mastectomy with or without immediate reconstruction from 2004-2007. We will use these data to develop risk prediction models for wound complications, taking into account the specific type of breast reconstructive surgery. We will then validate the risk prediction models with claims data from later years. These results will help determine if all of a subset of women could potentially benefit from delayed reconstruction, and if there are specific processes of care that protect against wound complications. This study will provide significant new information which can be used to improve outcomes for women with breast cancer. PUBLIC HEALTH RELEVANCE: We propose to determine rates and risk factors for infectious and noninfectious wound complications after mastectomy with immediate compared to delayed breast reconstruction. We will develop an algorithm to predict wound complication rates. This study will provide important new information to determine the optimal timing and type of reconstructive surgery for women after mastectomy based on their underlying illnesses.

描述（由申请人提供）：在其一生中，每八名美国妇女中就有一名将被诊断患有乳腺癌，2008年有182，500例新发病例。美国每年进行超过57，000例乳房再造手术。乳房再造可以在乳房切除术后立即进行，也可以推迟数月至数年后进行。在美国，60%的重建涉及组织扩张器，然后更换为永久性植入物。自体皮瓣乳房再造是不常见的。没有随机试验来确定即时与延迟乳房再造的比较有效性。关于重建的类型和时间的决定是基于个体外科医生和患者的偏好。乳房再造并发症发生率和结局主要来自小型研究，几乎完全来自单一机构。尚未进行全面的多中心研究，以确定立即与延迟重建后手术部位感染和其他伤口并发症的发生率。在单中心研究中，与单纯乳房切除术相比，即刻乳房再造术后的手术部位感染率显著更高。在种植体的情况下，2/3的感染种植体丢失。我们建议使用来自美国最大的商业保险人群的地理上不同的纵向索赔数据，以确定乳房切除术和立即与延迟重建后手术部位感染和非感染性伤口并发症的发生率。我们将确定2004-2007年接受乳房切除术（有或没有立即重建）的女性感染性和非感染性伤口并发症风险的相关因素。我们将使用这些数据来开发伤口并发症的风险预测模型，同时考虑到乳房再造手术的特定类型。然后，我们将使用以后几年的索赔数据验证风险预测模型。这些结果将有助于确定是否所有的女性都可能从延迟重建中受益，以及是否有特定的护理过程可以防止伤口并发症。这项研究将提供重要的新信息，可用于改善乳腺癌妇女的预后。 公共卫生关系：我们建议确定乳房切除术后感染性和非感染性伤口并发症的发生率和风险因素，并与立即和延迟乳房再造进行比较。我们将开发一种算法来预测伤口并发症发生率。这项研究将提供重要的新信息，以确定最佳的时机和类型的重建手术后的妇女乳房切除术的基础上，他们的基础疾病。