A Machine Learning Approach to Predicting Donor Site Complications Following DIEP Flap Harvest

Abstract

Background: The additional donor site incisions in autologous breast reconstruction can predispose to abdominal complications. The purpose of this study is to delineate predictors of donor site morbidity following DIEP flap harvest and use those predictors to develop a machine learning model that can identify high risk patients. Methods: This is a retrospective study of women who underwent DIEP flap reconstruction from 2011 to 2020. Donor site complications included abdominal wound dehiscence, necrosis, infection, seroma, hematoma, and hernia within 90 days postoperatively. Multivariate regression analysis was used to identify predictors for donor site complications. Variables found significant were used to construct machine learning models to predict donor site complications. Results: Of 258 patients, 39 patients (15 percent) developed abdominal donor site complications, which included 19 cases of dehiscence, 12 cases of partial necrosis, 27 cases of infection, and 6 cases of seroma. On univariate regression analysis, age (p = 0.026), body mass index (p = 0.003), mean flap weight (p = 0.006), and surgery time (p = 0.035) were predictors of donor site complications. On multivariate regression analysis, age (p = 0.025), body mass index (p = 0.010), and surgery duration (p = 0.048) remained significant. Radiographic features of obesity, such as abdominal wall thickness and total fascial diastasis were not significant predictors of complications (p > 0.05). In our machine learning algorithm, the logistic regression model was the most accurate at predicting donor site complications with accuracy of 82 percent, specificity of 0.93, and negative predictive value of 0.87. Conclusion: This study demonstrates that body mass index is superior to radiographic features of obesity in predicting donor site complications following DIEP flap harvest. Other predictors include older age and longer surgery duration. Our logistic regression machine learning model has the potential to quantify risk of donor site complications.

Patient-Reported Abdominal Morbidity Following Abdomen-Based Breast Reconstruction

“…To our knowledge, age has not been identified as an independent risk factor for hernia after abdominal flap harvest in previous studies, though it is a known risk factor for donor site complications following the use of the abdominal donor site as well as incisional hernia following laparotomy. [27][28][29] Prospective, population-based studies are needed to delineate the impact of patient age on hernia formation in this population.…”