Early postoperative outcomes in implant, pedicled, and free flap reconstruction for breast cancer: an analysis of 23,834 patients from the ACS-NSQIP datasets

Karadsheh, Murad J.; Tyrell, Richard; Deng, Mengying; Egleston, Brian L.; Krupp, James; Shafqat, M. Shuja; Patel, Sameer A.

doi:10.1007/s10549-020-06073-8

Cited by 8 publications

(2 citation statements)

References 25 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…8 Lastly, ICD-10-PCS coding terminology does not specify if certain ABR flaps, such as TRAM flaps, were free or pedicled, a factor which may impact patient access, complication rates, and LOS. [52][53][54] Future smaller-scale investigations should leverage enhanced granularity and longitudinality in ABR care, more qualitative physician-and patientreported metrics, and greater insights into specific barriers to ABR to ensure optimal ABR utilization and emphatic progress toward equitable postmastectomy reconstructive options for all US patients.…”

Section: Limitationsmentioning

confidence: 99%

Updated Trends and Outcomes in Autologous Breast Reconstruction in the United States, 2016–2019

Shah,

Amakiri,

Cevallos

et al. 2024

Ann Plast Surg

View full text Add to dashboard Cite

Introduction Autologous breast reconstruction (ABR) has increased in recent decades, although concerns for access remain. As such, our goal is to trend national demographics and operative characteristics of ABR in the United States. Methods Using the National Inpatient Sample, 2016–2019, the International Classification of Disease, Tenth Edition codes identified adult female encounters undergoing ABR. Demographics and procedure-related characteristics were recorded. Discharge weights generated national estimates. Statistical analysis included univariate testing and multivariate regression modeling. Results A total of 52,910 weighted encounters met the criteria (mean age, 51.5 ± 10.0 years). Autologous breast reconstruction utilization increased (Δ = +5%), 2016–2019, primarily driven by a rise in deep inferior epigastric perforator (DIEP) reconstructions (Δ = +28%; incidence rate ratio [IRR], 1.070; P < 0.001), which were predominant throughout the study period (69%). More recent surgery year, bilateral reconstruction, higher income levels, commercial insurance, and care in the South US region increased the odds of DIEP-based ABR (P ≤ 0.036). Transverse rectus abdominis myocutaneous flaps, bilateral reconstructions, higher comorbidity levels, and experiencing complications increased the length of stay (P ≤ 0.038). Most ABRs (75%) were privately insured. The rates of immediate reconstructions increased over the study period (from 26% to 46%; IRR, 1.223; P < 0.001), as did the rates of bilateral reconstructions (from 54% to 57%; IRR, 1.026; P = 0.030). The rates of ABRs performed at teaching hospitals remained high (90% to 93%; P = 0.242). Conclusions As of 2019, ABR has become more prevalent, with the DIEP flap constituting the most common modality. With the increasing ABR popularity, efforts should be made to ensure geographic and financial accessibility.

show abstract

Section: Limitationsmentioning

confidence: 99%

Updated Trends and Outcomes in Autologous Breast Reconstruction in the United States, 2016–2019

Shah,

Amakiri,

Cevallos

et al. 2024

Ann Plast Surg

View full text Add to dashboard Cite

show abstract

“…Autologous tissue breast reconstruction has been demonstrated to have improved quality of life and aesthetic satisfaction 5–9 . Nevertheless, medical and surgical complications are more common after autologous reconstruction than implant reconstruction 10 …”

mentioning

confidence: 99%

Breast Reconstruction Free Flap Failure

et al. 2022

View full text Add to dashboard Cite

BackgroundMicrovascular free tissue transfer is an increasingly popular modality for autologous tissue breast reconstruction. However, flap failure remains an ominous risk that continues to plague surgeons and patients even in the setting of meticulous surgical technique and monitoring. Venous and arterial thromboses are the leading causes of free flap failure. The purpose of this study was to determine whether thrombocytosis is associated with breast free flap failure.MethodsA retrospective study was conducted of breast reconstruction with free flaps in North America between 2015 and 2020 using the National Surgical Quality Improvement Program database. Patient comorbidities and preoperative laboratory tests were used to determine risk factors for free flap failure.ResultsDuring the study interval, 7522 female patients underwent breast reconstruction with free flaps, and flap failure occurred in 2.7% patients (n = 203). In multivariate regression analysis, breast free flap failure was significantly higher in patients smoking cigarettes within the past year (P = 0.030; AOR, 1.7) and dyspnea on moderate exertion or at rest (P = 0.025; AOR, 2.6). Furthermore, each 50 K/mcL elevation in platelet count was independently associated with an increased odds of flap failure (P < 0.001; AOR, 1.2). Patients experienced significantly higher rates of flap failure with platelet counts greater than 250 K/mcL (P = 0.004), which remained significant through progressively increasing thresholds up to 450 K/mcL.ConclusionsPlatelet count greater than 250 K/mcL is associated with progressively increasing risk of free flap failure in breast reconstruction. Future studies of personalized patient anticoagulation protocols based on hemostatic metrics may improve free flap survival after autologous tissue breast reconstruction.

show abstract

Comparison of short-term outcomes between pedicled- and free-flap autologous breast reconstruction: a nationwide inpatient database study in Japan

et al. 2022

View full text Add to dashboard Cite

Early postoperative outcomes in implant, pedicled, and free flap reconstruction for breast cancer: an analysis of 23,834 patients from the ACS-NSQIP datasets

Cited by 8 publications

References 25 publications

Updated Trends and Outcomes in Autologous Breast Reconstruction in the United States, 2016–2019

Updated Trends and Outcomes in Autologous Breast Reconstruction in the United States, 2016–2019

Breast Reconstruction Free Flap Failure

Comparison of short-term outcomes between pedicled- and free-flap autologous breast reconstruction: a nationwide inpatient database study in Japan

Contact Info

Product

Resources

About