IMMEDIATE VS DELAYED RECONSTRUCTION AND BREAST CANCER SURGERY COMPLICATIONS

在他们的一生中，每八名美国妇女中就有一名被诊断患有乳腺癌，有182，500名 2008年新增病例。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，然后更换为永久性组织扩张器。 植入自体皮瓣乳房再造是不常见的。没有随机试验 确定即时与延迟乳房再造的比较有效性。之决定 重建的类型和时机取决于外科医生和患者的个人偏好。乳腺 重建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。全面的多中心研究，以确定 立即与延迟重建后的手术部位感染和其他伤口并发症 被执行。在单中心研究中，手术后手术部位感染率明显更高， 与单纯乳房切除术相比，在植入物的情况下，2/3的感染 植入物丢失。 我们建议使用来自最大的商业保险公司的地理上不同的纵向索赔数据 确定手术部位感染和非感染性伤口的发生率 乳房切除术后的并发症以及立即与延迟重建。我们将决定因素 与接受乳房切除术的女性感染性和非感染性伤口并发症的风险相关 从2004年至2007年，无论是否立即重建。我们将使用这些数据来开发风险 伤口并发症的预测模型，考虑到特定类型的乳房再造 手术然后，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 这将有助于确定是否所有的一部分妇女都可能从延迟重建中受益， 如果有特定的护理过程可以防止伤口并发症。本研究将提供 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.