Davila, Armando A.
(Division of Plastic and Reconstructive Surgery, Northwestern University, Feinberg School of Medicine)
,
Seth, Akhil K.
(Division of Plastic and Reconstructive Surgery, Northwestern University, Feinberg School of Medicine)
,
Wang, Edward
(Department of Surgery, Northwestern University, Feinberg School of Medicine)
,
Hanwright, Philip
(Division of Plastic and Reconstructive Surgery, Northwestern University, Feinberg School of Medicine)
,
Bilimoria, Karl
(Department of Surgery, Northwestern University, Feinberg School of Medicine)
,
Fine, Neil
(Division of Plastic and Reconstructive Surgery, Northwestern University, Feinberg School of Medicine)
,
Kim, John Y.S.
(Division of Plastic and Reconstructive Surgery, Northwestern University, Feinberg School of Medicine)
Background Acellular dermal matrix (ADM) allografts and their putative benefits have been increasingly described in prosthesis based breast reconstruction. There have been a myriad of analyses outlining ADM complication profiles, but few large-scale, multi-institutional studies exploring these outco...
Background Acellular dermal matrix (ADM) allografts and their putative benefits have been increasingly described in prosthesis based breast reconstruction. There have been a myriad of analyses outlining ADM complication profiles, but few large-scale, multi-institutional studies exploring these outcomes. In this study, complication rates of acellular dermis-assisted tissue expander breast reconstruction were compared with traditional submuscular methods by evaluation of the American College of Surgeon's National Surgical Quality Improvement Program (NSQIP) registry. Methods Patients who underwent immediate tissue expander breast reconstruction from 2006-2010 were identified using surgical procedure codes. Two hundred forty tracked variables from over 250 participating sites were extracted for patients undergoing acellular dermis-assisted versus submuscular tissue expander reconstruction. Thirty-day postoperative outcomes and captured risk factors for complications were compared between the two groups. Results A total of 9,159 patients underwent tissue expander breast reconstruction; 1,717 using acellular dermis and 7,442 with submuscular expander placement. Total complications and reconstruction related complications were similar in both cohorts (5.5% vs. 5.3%, P=0.68 and 4.7% vs. 4.3%, P=0.39, respectively). Multivariate logistic regression revealed body mass index and smoking as independent risk factors for reconstructive complications in both cohorts (P<0.01). Conclusions The NSQIP database provides large-scale, multi-institutional, independent outcomes for acellular dermis and submuscular breast reconstruction. Both thirty-day complication profiles and risk factors for post operative morbidity are similar between these two reconstructive approaches.
Background Acellular dermal matrix (ADM) allografts and their putative benefits have been increasingly described in prosthesis based breast reconstruction. There have been a myriad of analyses outlining ADM complication profiles, but few large-scale, multi-institutional studies exploring these outcomes. In this study, complication rates of acellular dermis-assisted tissue expander breast reconstruction were compared with traditional submuscular methods by evaluation of the American College of Surgeon's National Surgical Quality Improvement Program (NSQIP) registry. Methods Patients who underwent immediate tissue expander breast reconstruction from 2006-2010 were identified using surgical procedure codes. Two hundred forty tracked variables from over 250 participating sites were extracted for patients undergoing acellular dermis-assisted versus submuscular tissue expander reconstruction. Thirty-day postoperative outcomes and captured risk factors for complications were compared between the two groups. Results A total of 9,159 patients underwent tissue expander breast reconstruction; 1,717 using acellular dermis and 7,442 with submuscular expander placement. Total complications and reconstruction related complications were similar in both cohorts (5.5% vs. 5.3%, P=0.68 and 4.7% vs. 4.3%, P=0.39, respectively). Multivariate logistic regression revealed body mass index and smoking as independent risk factors for reconstructive complications in both cohorts (P<0.01). Conclusions The NSQIP database provides large-scale, multi-institutional, independent outcomes for acellular dermis and submuscular breast reconstruction. Both thirty-day complication profiles and risk factors for post operative morbidity are similar between these two reconstructive approaches.
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문제 정의
In spite of the limitations surrounding the NSQIP database, the large-scale ( > 9,000 patient), multi-institutional ( > 240 center) nature of the database avoids the pitfalls of inter-institution variance of procedure found in isolated retrospective cohorts, while also providing sufficient statistical power for multivariate analyses that is not always feasible by single institutions. This study is the first comparative analysis of ADM-assisted tissue expander breast reconstruction utilizing the NSQIP registry. In summary, complication profiles of ADM and traditional submuscular reconstruction appear to be similar.
In summary, complication profiles of ADM and traditional submuscular reconstruction appear to be similar. This study lends credence to increasing evidence that obesity and smoking are major factors in the development of postoperative complications following acellular dermis assisted tissue expander breast reconstruction. However, these, high-risk patients were no more likely to develop reconstruction related complication with the use of ADM than without.
가설 설정
a)A single patient may experience more than one complication.
Defined as all superficial wound infections, deep wound infections, and organ space infections; b)Denotes statistical significance.
제안 방법
The patient demographics included for analysis consisted of age, race, ethnicity, body mass index (BMI), smoking ( < 1 year prior to surgery), radiotherapy ( < 90 days prior to surgery), chemotherapy ( < 30 days prior to surgery), chronic use of steroids for medical disease, and previous operation ( < 30 days prior to surgery).
01). This effect was independent of the effects of diabetes and hypertension, which were adjusted for in the multivariate analysis. Antony et al.
대상 데이터
[15], with sample sizes of 96, 283, and 343 patients respectively. Although statistically sound and providing valuable insight into risk factors for acellular dermis use, these studies may be insufficiently powered when compared to the nine thousand patients captured in this study. Additionally, although these studies have explored risk factors that pertain to morbidity with acellular dermal matricies, there have to been no comparisons between these purported risk factors and those that are inherent to submuscular reconstruction.
데이터처리
Bivariate comparison of demographics and complications between the acelluar dermis assisted and submuscular reconstruction groups were performed with a chi-squared test and Fisher’s exact test (for small cell counts) for categorical variables, and independent t-tests for continuous variables.
05 was considered significant. To account for potential confounders, multivariate analysis was performed calculating the adjusted probabilities for complications and odds ratio. A bivariate screen was used to identify variables that demonstrated significance at P-value less than 0.
이론/모형
Specifically, the rates of general reconstructive complication variables were evaluated, including surgical site infection, wound disruption, and prosthesis failure, all of which showed no statistical differences between cohorts. In order to better quantify these complications and compare risk factors for developing complications in each cohort, bivariate and multivariate logistic regression were used.
성능/효과
Conversely, under-filling of the expander can lead to seroma formation causing poor incorporation of the dermal graft and increasing risk of infection. However, BMI was a risk factor for complications independent of ADM use, as the odds of reconstructive complications was not statistically different between the acellular dermis and submuscular cohorts (OR, 1.10; 95% CI,1.07 to 1.14 vs. OR, 1.08; 95% CI,1.06 to 1.09). As such, obesity should not be considered a contraindication to acellular dermis use.
Increased BMI connoted a higher complication rate in all secondary outcomes (P < 0.01), with 1-unit BMI increase associated with a 10%, 13%, and 12% increased odds of any operative site infection, wound disruption, and prosthesis failure, respectively (Table 5).
In this series, ADM did not connote an increased complication risk profile than traditional, submuscular tissue expander reconstruction. Specifically, the rates of general reconstructive complication variables were evaluated, including surgical site infection, wound disruption, and prosthesis failure, all of which showed no statistical differences between cohorts. In order to better quantify these complications and compare risk factors for developing complications in each cohort, bivariate and multivariate logistic regression were used.
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