D. J. Gerth1, J. Tashiro1, S. R. Thaller1 1University Of Miami,DIvision Of Plastic Surgery, DeWitt Daughtry Family Department Of Surgery,Miami, FL, USA
Introduction: Abdominal based breast reconstruction may be performed using several techniques, including pedicled transverse rectus abdominis myocutaneous (TRAM), free TRAM, and deep inferior epigastric perforator (DIEP) free flaps. DIEP flaps have the advantage of complete rectus abdominis sparing during the procedure, thus decreasing donor site morbidity. The aim of this study is to determine whether the surgical advantages of the DIEP flap impact postoperative outcomes vs. the free TRAM flap (fTRAM).
Methods: We identified cases of DIEP (ICD-9-CM 85.74) and fTRAM (85.73) breast reconstruction within the Nationwide Inpatient Sample (NIS) database (2010-2011). Males were excluded from the analysis. Demographic and socioeconomic characteristics, comorbidities, postoperative complications (reoperation, hemorrhage, hematoma, seroma, pulmonary embolus, wound infection, and flap loss) were examined, along with endpoints of length of stay (LOS) and total charges (TC). Standard statistical methods and risk-adjusted multivariate analyses were used; all cases were weighted to project national estimates.
Results: Overall, 15,836 cases were identified, with 9,699 (61%) DIEP and 6,137 (39%) fTRAM reconstructions. Within the cohort, 70% were Caucasian, 97% were insured, and 83% of patients were treated in a teaching hospital setting. LOS was longer among fTRAM patients, whereas TC were lower, p<0.001. There were no in-hospital mortalities during the study period. DIEP patients were more likely to be obese (OR=1.2), p<0.001. The fTRAM cohort was more likely to suffer pneumonia (OR=3.7), wound infection (OR=1.7), and wound dehiscence (OR=4.3), p<0.001. Type of reconstruction did not affect risk of revision, hemorrhage, hematoma, seroma, or flap loss on bivariate analysis. Risk-adjusted multivariate analysis demonstrated that fTRAM was an independent risk factor for increased length of stay (OR=1.6) and postoperative complications (OR=1.3), p<0.001. DIEP was an independent risk factor for increased total charges (OR=1.5), p=0.001.
Conclusion: Patients undergoing fTRAM breast reconstruction were more likely to suffer postoperative complications and an increased length of stay; total charges however, were higher for the DIEP cohort. Additional research is necessary to elucidate patterns of technique availability to improve cost-utilization.