Outcomes Comparison for Microsurgical Breast Reconstruction in Specialty Surgery Hospitals Versus Tertiary Care Facilities

Abstract

Background:Postoperative monitoring is crucial in the care of free flap breast reconstruction patients. Tertiary care facilities (TCFs) provide postoperative monitoring in an ICU after surgery. Specialty surgery hospitals (SSHs) do not have ICUs, but these facilities perform free flap breast reconstruction as well. Are outcomes comparable between the 2 facilities in terms of flap reexploration times and overall success?Methods:Retrospective study including 163 SSH and 157 TCF patients. Primary predictor was facility in which the procedure was performed. Secondary predictors included operative, demographic, and comorbidity data. Primary outcomes were flap take back rate and flap failures. Secondary outcomes were total time from adverse event noticed in the flap to returning to the operating room (OR) and total time from decision made to return to the OR to returning to the OR (decision made). Tertiary outcomes were length of stay, operative times, and blood loss.Results:Patients at the TCF were generally less healthy than SSH patients. Salvage rates and failure rates were similar between the 2 institutions. Adverse event noticed and decision made times did not differ between the 2 facilities. Overall flap success rate was 98.22% at SSH and 98.81% at TCF. No primary or secondary predictors had a significant correlation with increased odds for flap failure.Conclusion:SSHs can offer similar outcomes in free flap breast reconstruction with just as effective clinical response times to endangered flaps as found in a TCF. However, surgery at an SSH may best be reserved for healthier patients.

Overall Complication Rates of DIEP Flap Breast Reconstructions in Germany—A Multi-Center Analysis Based on the DGPRÄC Prospective National Online Registry for Microsurgical Breast Reconstructions

“…Mean BMI was 26.28 kg/m 2 and therefore slightly higher in comparison to the population investigated Vanschoonbeek et al (24.9 kg/m 2 ) [32] and almost equal to the mean BMI of the study population investigated by Unukovych et al (26.2 kg/m 2 ) [30]. Neoadjuvant chemotherapy was administered in approximately 50% of all cases, complying with numbers found in the studies of Vemula et al [29] and Unukovych et al [30]. Overall, immediate breast reconstruction (IBR) was performed in~25% of all cases which seems relatively low compared to the international literature [14,33,34].…”

“…Overall, the presented data show that free DIEP transfer for breast reconstruction is performed under high quality standards over a broad number of centers in Germany, with total and partial flap loss rates as low as 2.0% and 1.1% respectively, and emergent vascular revision surgery being performed in 4.3% of cases. The outcome and complication rates deduced from the national registry compare to recent large-scale international studies and show no significant disparity in this regard [ 29 , 30 , 31 , 32 ]. The study population of Vemula et al (478 DIEP flaps) showed overall DIEP flap success rates of 98.2% at specialty surgery hospitals and 96.4% at tertiary care facilities [ 29 ].…”

“…The outcome and complication rates deduced from the national registry compare to recent large-scale international studies and show no significant disparity in this regard [29][30][31][32]. The study population of Vemula et al (478 DIEP flaps) showed overall DIEP flap success rates of 98.2% at specialty surgery hospitals and 96.4% at tertiary care facilities [29]. Unukovych et al found a reoperation rate of 15.9% in a study population of 503 DIEP flaps.…”

Operative Time and Flap Failure in Unilateral and Bilateral Free Flap Breast Reconstruction

“…The flap failure rate observed in this dataset (5.5%) is higher than what is reported in the literature (<2%). 24 There may be several reasons for this discrepancy. The first is that our dataset captures cases from 2005 to 2010.…”

Detailed analysis of the impact of surgeon and hospital volume in microsurgical breast reconstruction

“…However, prior investigations have not attempted to distinguish between the volume‐outcome effects of surgeon versus hospital. Further, what constitutes “high volume” has been inconsistently described in the literature (Albornoz, Cordeiro, et al, 2012b; Billig et al, 2017; Kulkarni, Sears, Atisha, & Alderman, 2013; Tanna et al, 2012; Vemula et al, 2017). Prior studies have utilized a priori definitions or quantiles to classify volume groups, but no robust data‐driven method has been utilized to date.…”