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The significance of timing in breast reconstruction after mastectomy: An ACS-NSQIP analysis
S. Knoedler, M. Kauke-Navarro, L. Knoedler, S. Friedrich, HS. Ayyala, V. Haug, O. Didzun, G. Hundeshagen, A. Bigdeli, U. Kneser, HG. Machens, B. Pomahac, DP. Orgill, PN. Broer, AC. Panayi
Jazyk angličtina Země Nizozemsko
Typ dokumentu přehledy, časopisecké články
- MeSH
- lidé MeSH
- mamoplastika * škodlivé účinky metody MeSH
- mastektomie škodlivé účinky metody MeSH
- nádory prsu * komplikace MeSH
- pooperační komplikace epidemiologie etiologie chirurgie MeSH
- reoperace škodlivé účinky MeSH
- retrospektivní studie MeSH
- Check Tag
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
BACKGROUND: A variety of breast reconstruction (BR) options are available. The significance of timing on outcomes remains debated. This study aims to compare complications in breast cancer patients undergoing implant-based and autologous BR immediately after mastectomy or at a delayed time point. METHODS: We reviewed the ACS-NSQIP database (2008-2021) to identify all female patients who underwent BR for oncological purposes. Outcomes were stratified by technique (implant-based versus autologous) and timing (immediate versus delayed), and included 30-day mortality, reoperation, (unplanned) readmission, and surgical and medical complications. RESULTS: A total of 21,560 patients were included: 11,237 (52%) implant-based (9791/87% immediate, 1446/13% delayed) and 10,323 (48%) autologous (8378/81% immediate, 1945/19% delayed). Complications occurred in 3666 (17%) patients (implant-based: n = 1112/11% immediate, n = 64/4.4% delayed cohorts; Autologous: n = 2073/25% immediate, n = 417/21% delayed cohorts). In propensity score weighting (PSW) analyses, immediate BR was associated with significantly more complications than delayed BR (p < 0.0001). This was the case for both implant-based and autologous BR, with a greater difference between the two time points noted in implant-based. Confounder-adjusted multivariable analyses confirmed these results. CONCLUSION: At the 30-day time point, delayed BR is associated with significantly lower complication rates than immediate BR, in both the implant-based and autologous cohorts. These findings are not a blanket recommendation in favor of immediate and/or delayed BR. Instead, our insights may guide surgeons and patients in decision-making and help refine patients' eligibility in a case-by-case workup.
Citace poskytuje Crossref.org
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- $a Knoedler, Samuel $u Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Department of Plastic Surgery and Hand Surgery, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany; Division of Plastic Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT, USA
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- $a The significance of timing in breast reconstruction after mastectomy: An ACS-NSQIP analysis / $c S. Knoedler, M. Kauke-Navarro, L. Knoedler, S. Friedrich, HS. Ayyala, V. Haug, O. Didzun, G. Hundeshagen, A. Bigdeli, U. Kneser, HG. Machens, B. Pomahac, DP. Orgill, PN. Broer, AC. Panayi
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- $a BACKGROUND: A variety of breast reconstruction (BR) options are available. The significance of timing on outcomes remains debated. This study aims to compare complications in breast cancer patients undergoing implant-based and autologous BR immediately after mastectomy or at a delayed time point. METHODS: We reviewed the ACS-NSQIP database (2008-2021) to identify all female patients who underwent BR for oncological purposes. Outcomes were stratified by technique (implant-based versus autologous) and timing (immediate versus delayed), and included 30-day mortality, reoperation, (unplanned) readmission, and surgical and medical complications. RESULTS: A total of 21,560 patients were included: 11,237 (52%) implant-based (9791/87% immediate, 1446/13% delayed) and 10,323 (48%) autologous (8378/81% immediate, 1945/19% delayed). Complications occurred in 3666 (17%) patients (implant-based: n = 1112/11% immediate, n = 64/4.4% delayed cohorts; Autologous: n = 2073/25% immediate, n = 417/21% delayed cohorts). In propensity score weighting (PSW) analyses, immediate BR was associated with significantly more complications than delayed BR (p < 0.0001). This was the case for both implant-based and autologous BR, with a greater difference between the two time points noted in implant-based. Confounder-adjusted multivariable analyses confirmed these results. CONCLUSION: At the 30-day time point, delayed BR is associated with significantly lower complication rates than immediate BR, in both the implant-based and autologous cohorts. These findings are not a blanket recommendation in favor of immediate and/or delayed BR. Instead, our insights may guide surgeons and patients in decision-making and help refine patients' eligibility in a case-by-case workup.
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- $a Kauke-Navarro, Martin $u Division of Plastic Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT, USA
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- $a Friedrich, Sarah $u Department of Mathematical Statistics and Artificial Intelligence in Medicine, University of Augsburg, Augsburg, Germany
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- $a Ayyala, Haripriya S $u Division of Plastic Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT, USA
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- $a Haug, Valentin $u Department of Hand, Plastic and Reconstructive Surgery, Microsurgery, Burn Trauma Center, Ludwigshafen, University of Heidelberg, Ludwigshafen, Germany
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