假体乳房再造术合并症指标的比较分析

IF 2 3区医学 Q2 SURGERY

Journal of Plastic Reconstructive and Aesthetic Surgery Pub Date : 2024-11-15 DOI:10.1016/j.bjps.2024.11.015

Allen Green , Shannon D. Francis , Maheen F. Akhter , Rahim S. Nazerali

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引用次数: 0

摘要

最近的研究使用合并症指数对包括整形手术在内的多个手术领域的术后并发症风险进行分层。然而，这类研究在基于假体的乳房重建（IBBR）中缺乏。了解合并症评分对IBBR术后预后的影响，有助于确定术后可能需要额外医学监测的患者。方法：我们使用Merative™Marketscan®研究数据库对2017年1月至2022年12月期间接受IBBR的成年女性患者进行回顾性分析。使用ICD-10诊断代码计算患者在四种不同合并症指标上的得分。采用卡方检验进行人口统计学分析，并采用多变量logistic回归控制人口统计学和手术变量，以确定合并症指标与不良结局之间的关系。结果16287例IBBR患者中，3145例（19.3%）在90天内出现并发症。回归分析显示，与Charlson合并症指数、Elixhauser合并症指数和改良衰弱指数11-Item相比，改良衰弱指数5-Item （mFI-5）与并发症的相关性最强（优势比=1.25[1.18,1.32]）。进一步的回归分析显示，5例mFI-5合并症中有4例是术后并发症的独立危险因素。结论本研究强调了IBBR合并症指标与术后不良预后之间的重要关联。与分析的其他指标相比，mFI-5在术后风险分层方面表现优异。这些发现表明，在临床环境中使用mFI-5可能有助于识别高合并症患者，这些患者可能受益于额外的监测和预防措施。需要进一步的研究来了解如何减轻这些患者增加的术后并发症风险。

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Comparative analysis of comorbidity indexes in implant-based breast reconstruction

Introduction

Recent studies have used comorbidity indexes to stratify postsurgical complication risk across multiple surgical fields, including plastic surgery. However, such studies are lacking in implant-based breast reconstruction (IBBR). Understanding how comorbidity scores affect postsurgical outcomes in IBBR can help identify patients who may require additional medical surveillance after surgery.

Methods

We conducted a retrospective analysis of adult female patients who underwent IBBR between January 2017 and December 2022 using the Merative™ Marketscan® Research Databases. ICD-10 diagnosis codes were used to calculate patients’ scores on four different comorbidity indexes. Chi-squared tests were performed for demographic analysis, and multivariable logistic regression controlling for demographic and surgical variables, was conducted to determine associations between comorbidity indexes and adverse outcomes.

Results

Among 16,287 IBBR patients, 3145 (19.3%) experienced a complication within 90 days. On regression analysis, the Modified Frailty Index 5-Item (mFI-5) demonstrated the strongest associations with complications (odds ratio=1.25 [1.18, 1.32]), compared to the Charlson Comorbidity Index, Elixhauser Comorbidity Index, and Modified Frailty Index 11-Item. Further regression analysis revealed that four out of the five mFI-5 comorbidities were independent risk factors for postsurgical complications.

Conclusion

This study highlights important associations between comorbidity indexes and adverse postoperative outcomes in IBBR. mFI-5 demonstrated superior performance in postoperative risk stratification compared to the other indexes analyzed. These findings suggest that using mFI-5 in clinical settings may help identify high comorbidity patients who may benefit from additional monitoring and prophylactic measures. Further research is needed to understand how to mitigate the increased postoperative complication risk in these patients.

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来源期刊

Journal of Plastic Reconstructive and Aesthetic Surgery 医学-外科

CiteScore

3.10

自引率

11.10%

发文量

578

审稿时长

3.5 months

期刊介绍： JPRAS An International Journal of Surgical Reconstruction is one of the world''s leading international journals, covering all the reconstructive and aesthetic aspects of plastic surgery. The journal presents the latest surgical procedures with audit and outcome studies of new and established techniques in plastic surgery including: cleft lip and palate and other heads and neck surgery, hand surgery, lower limb trauma, burns, skin cancer, breast surgery and aesthetic surgery.