IMMEDIATE VS DELAYED RECONSTRUCTION AND BREAST CANCER SURGERY COMPLICATIONS

在她们的一生中，每八名美国女性中就有一名被诊断出患有乳腺癌，这一数字为182,500 2008年新增病例。在美国，每年有超过57,000例乳房重建手术。 乳房重建可以在乳房切除后立即进行，也可以推迟几个月到几年后进行。 在美国，60%的重建手术涉及组织扩张器，然后是永久的 植入。自体皮瓣乳房重建术较少见。目前还没有随机试验 确定立即乳房重建术和延迟乳房重建术的比较效果。关于这一问题的决定 重建的类型和时间取决于个别外科医生和患者的喜好。乳房 重建并发症的发生率和结果主要来自小型研究，以及 几乎完全来自单一机构。全面的多中心研究，以确定 即刻重建与延迟重建相比，手术部位感染和其他伤口并发症没有 已经完成了。在单中心研究中，术后手术部位感染率显著升高。 与仅切除乳房相比，立即重建。在有植入物的情况下，三分之二的感染者 植入物丢失了。 我们建议使用不同地域的纵向索赔数据，这些数据来自最大的商业保险公司 美国人群确定手术部位感染和非感染性伤口的发生率 乳房切除术后并发症及即刻重建与延迟重建的比较。我们将决定因素 乳房切除术后女性感染和非感染性伤口并发症的风险 无论是否立即重建，2004年至2007年。我们将使用这些数据来开发风险 伤口并发症预测模型，考虑特定类型的乳房重建 做手术。然后，我们将用后来几年的索赔数据来验证风险预测模型。这些结果 将有助于确定是否所有子集的妇女都可能从延迟的重建中受益，以及 是否有特定的护理程序来防止伤口并发症。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。

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.