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: Pedicled breast reconstruction is the mainstay in the treatment algorithm for many plastic surgeons. While indications vary for each technique, there is considerable overlap in the type of defect each flap is used to reconstruct. This study aims to determine the impact that flap selection has on postoperative outcomes and resource utilization.
Methods: We reviewed the Nationwide Inpatient Sample (NIS) database (2010-2011) for cases of latissimus dorsi (LD; ICD-9-CM 85.71) and pedicled transverse abdominis myocutaneous (pTRAM; 85.72) breast reconstruction. Males were excluded from the analysis. Demographic, socioeconomic, and clinical factors were assessed, along with postoperative complications (including reoperation, hemorrhage, hematoma, seroma, pulmonary embolus, wound infection, and flap loss), length of admission, and total charges. Chi-squared and multivariate analyses were performed to identify independent risk factors of increased resource utilization and complications following reconstructive surgery. Cases were weighted to represent national estimates.
Results: Our comparison was comprised of 29,074 cases, of which 17,670 (61%) were LD and 11,405 (39%) were pTRAM. In the cohort, 74% were Caucasian, 95% were insured, and 66% of patients were treated in a teaching hospital setting. There were 24 mortalities (15 LD, 9 pTRAM). Patients in the LD cohort were more likely to be obese (OR=1.3), and suffer from complications including flap loss (OR=1.4), wound infection (OR=1.6), wound dehiscence (OR=2.2) and hematoma (OR=1.3), p<0.05. Patients undergoing pTRAM were more likely to undergo surgical revision (OR=6.9), suffer from systemic infection (OR=1.8), pneumonia (OR=5.0), or pulmonary embolism (OR=29.2), p<0.05. There was no difference in postoperative hemorrhage. Total charges and length of stay were higher for pTRAM, p<0.001. A risk-adjusted multivariate analysis demonstrated that LD was an independent risk factor for postoperative complication (OR=1.4) and increased TC (OR=1.3), p<0.001. Conversely, undergoing pTRAM was an independent risk factor for increased length of stay (OR=6.3), p<0.001.
Conclusion: In an analysis of a large, population based database, patients undergoing LD breast reconstruction were found to have more costly hospitalizations and an increased risk for surgical site complications. Meanwhile, patients undergoing pTRAM had an increased risk for pulmonary complications and length of stay. Future procedure selection may be refined as additional characteristics are discovered using outcomes based research.