Nikki Rezania, Kelly A Harmon, Reilly Frauchiger-Ankers, Okensama La-Anyane, Keid Idrizi, Jocelyn To, Ethan M Ritz, David E Kurlander, Deana Shenaq, George Kokosis
{"title":"疝气和疝突发生的患者风险因素研究:元回归","authors":"Nikki Rezania, Kelly A Harmon, Reilly Frauchiger-Ankers, Okensama La-Anyane, Keid Idrizi, Jocelyn To, Ethan M Ritz, David E Kurlander, Deana Shenaq, George Kokosis","doi":"10.1055/s-0044-1788564","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong> This meta-regression aims to investigate risk factors for abdominal hernia and bulge in patients undergoing deep inferior epigastric perforator (DIEP) flaps and the effect of prophylactic mesh placement on postoperative complications.</p><p><strong>Methods: </strong> A systematic search was conducted in July of 2022 in alignment with the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Seventy-four studies published between 2000 and 2022 met the inclusion criteria. Sixty-four studies were included in the analysis for bulge and 71 studies were included in the analysis for hernia. Meta-regressions were run on the proportion of patients experiencing hernia or bulge to assess for patient risk factors and the role of prophylactic mesh placement. Proportions were transformed using the Freeman-Tukey double arcsine method.</p><p><strong>Results: </strong> The average rates of hernia and bulge after DIEP flaps were found to be 0.18% and 1.26%, respectively. Increased age (β = 0.0059, <i>p</i> = 0.0117), prior abdominal surgery (β = 0.0008, <i>p</i> = 0.046), and pregnancy history (β = -0.0015, <i>p</i> = 0<i>.</i>0001) were significantly associated with hernia. Active smoking (β = 0.0032, <i>p</i> = 0<i>.</i>0262) and pregnancy history (β = 0.0019, <i>p <</i> 0.0001) were significantly associated with bulge. Neither the perforator vessel laterality nor the number of perforator vessels harvested had any association with hernia or bulge. Prophylactic mesh placement was not associated with hernia or bulge.</p><p><strong>Conclusion: </strong> Understanding the comorbidities associated with hernia or bulge following DIEP flap breast reconstruction, such as advanced age, prior abdominal surgery, pregnancy history, and active smoking status, allows surgeons to proactively identify and educate high-risk patients. Future studies may further explore whether prophylactic mesh placement offers patients any benefit.</p>","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":" ","pages":""},"PeriodicalIF":2.2000,"publicationDate":"2024-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"A DIEP Dive into Patient Risk Factors for Hernia and Bulge Development: A Meta-regression.\",\"authors\":\"Nikki Rezania, Kelly A Harmon, Reilly Frauchiger-Ankers, Okensama La-Anyane, Keid Idrizi, Jocelyn To, Ethan M Ritz, David E Kurlander, Deana Shenaq, George Kokosis\",\"doi\":\"10.1055/s-0044-1788564\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong> This meta-regression aims to investigate risk factors for abdominal hernia and bulge in patients undergoing deep inferior epigastric perforator (DIEP) flaps and the effect of prophylactic mesh placement on postoperative complications.</p><p><strong>Methods: </strong> A systematic search was conducted in July of 2022 in alignment with the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Seventy-four studies published between 2000 and 2022 met the inclusion criteria. Sixty-four studies were included in the analysis for bulge and 71 studies were included in the analysis for hernia. Meta-regressions were run on the proportion of patients experiencing hernia or bulge to assess for patient risk factors and the role of prophylactic mesh placement. Proportions were transformed using the Freeman-Tukey double arcsine method.</p><p><strong>Results: </strong> The average rates of hernia and bulge after DIEP flaps were found to be 0.18% and 1.26%, respectively. Increased age (β = 0.0059, <i>p</i> = 0.0117), prior abdominal surgery (β = 0.0008, <i>p</i> = 0.046), and pregnancy history (β = -0.0015, <i>p</i> = 0<i>.</i>0001) were significantly associated with hernia. Active smoking (β = 0.0032, <i>p</i> = 0<i>.</i>0262) and pregnancy history (β = 0.0019, <i>p <</i> 0.0001) were significantly associated with bulge. Neither the perforator vessel laterality nor the number of perforator vessels harvested had any association with hernia or bulge. Prophylactic mesh placement was not associated with hernia or bulge.</p><p><strong>Conclusion: </strong> Understanding the comorbidities associated with hernia or bulge following DIEP flap breast reconstruction, such as advanced age, prior abdominal surgery, pregnancy history, and active smoking status, allows surgeons to proactively identify and educate high-risk patients. Future studies may further explore whether prophylactic mesh placement offers patients any benefit.</p>\",\"PeriodicalId\":16949,\"journal\":{\"name\":\"Journal of reconstructive microsurgery\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":2.2000,\"publicationDate\":\"2024-07-17\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of reconstructive microsurgery\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1055/s-0044-1788564\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"SURGERY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of reconstructive microsurgery","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1055/s-0044-1788564","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"SURGERY","Score":null,"Total":0}
A DIEP Dive into Patient Risk Factors for Hernia and Bulge Development: A Meta-regression.
Background: This meta-regression aims to investigate risk factors for abdominal hernia and bulge in patients undergoing deep inferior epigastric perforator (DIEP) flaps and the effect of prophylactic mesh placement on postoperative complications.
Methods: A systematic search was conducted in July of 2022 in alignment with the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Seventy-four studies published between 2000 and 2022 met the inclusion criteria. Sixty-four studies were included in the analysis for bulge and 71 studies were included in the analysis for hernia. Meta-regressions were run on the proportion of patients experiencing hernia or bulge to assess for patient risk factors and the role of prophylactic mesh placement. Proportions were transformed using the Freeman-Tukey double arcsine method.
Results: The average rates of hernia and bulge after DIEP flaps were found to be 0.18% and 1.26%, respectively. Increased age (β = 0.0059, p = 0.0117), prior abdominal surgery (β = 0.0008, p = 0.046), and pregnancy history (β = -0.0015, p = 0.0001) were significantly associated with hernia. Active smoking (β = 0.0032, p = 0.0262) and pregnancy history (β = 0.0019, p < 0.0001) were significantly associated with bulge. Neither the perforator vessel laterality nor the number of perforator vessels harvested had any association with hernia or bulge. Prophylactic mesh placement was not associated with hernia or bulge.
Conclusion: Understanding the comorbidities associated with hernia or bulge following DIEP flap breast reconstruction, such as advanced age, prior abdominal surgery, pregnancy history, and active smoking status, allows surgeons to proactively identify and educate high-risk patients. Future studies may further explore whether prophylactic mesh placement offers patients any benefit.
期刊介绍:
The Journal of Reconstructive Microsurgery is a peer-reviewed, indexed journal that provides an international forum for the publication of articles focusing on reconstructive microsurgery and complex reconstructive surgery. The journal was originally established in 1984 for the microsurgical community to publish and share academic papers.
The Journal of Reconstructive Microsurgery provides the latest in original research spanning basic laboratory, translational, and clinical investigations. Review papers cover current topics in complex reconstruction and microsurgery. In addition, special sections discuss new technologies, innovations, materials, and significant problem cases.
The journal welcomes controversial topics, editorial comments, book reviews, and letters to the Editor, in order to complete the balanced spectrum of information available in the Journal of Reconstructive Microsurgery. All articles undergo stringent peer review by international experts in the specialty.