Assessing the Relationship between Anxiety and Revision Surgery following Autologous Breast Reconstruction.

Autor:	Orr JP; From the Division of Plastic, Maxillofacial, and Oral Surgery, Duke University Medical Center; and the Department of Biostatistics and Bioinformatics, Duke Cancer Institute., Sergesketter AR; From the Division of Plastic, Maxillofacial, and Oral Surgery, Duke University Medical Center; and the Department of Biostatistics and Bioinformatics, Duke Cancer Institute., Shammas RL; From the Division of Plastic, Maxillofacial, and Oral Surgery, Duke University Medical Center; and the Department of Biostatistics and Bioinformatics, Duke Cancer Institute., Thomas AB; From the Division of Plastic, Maxillofacial, and Oral Surgery, Duke University Medical Center; and the Department of Biostatistics and Bioinformatics, Duke Cancer Institute., Cason RW; From the Division of Plastic, Maxillofacial, and Oral Surgery, Duke University Medical Center; and the Department of Biostatistics and Bioinformatics, Duke Cancer Institute., Zhao R; From the Division of Plastic, Maxillofacial, and Oral Surgery, Duke University Medical Center; and the Department of Biostatistics and Bioinformatics, Duke Cancer Institute., Broadwater G; From the Division of Plastic, Maxillofacial, and Oral Surgery, Duke University Medical Center; and the Department of Biostatistics and Bioinformatics, Duke Cancer Institute., Hollenbeck ST; From the Division of Plastic, Maxillofacial, and Oral Surgery, Duke University Medical Center; and the Department of Biostatistics and Bioinformatics, Duke Cancer Institute.
Jazyk:	angličtina
Zdroj:	Plastic and reconstructive surgery [Plast Reconstr Surg] 2019 Jul; Vol. 144 (1), pp. 24-33.
DOI:	10.1097/PRS.0000000000005696
Abstrakt:	Background: Revision procedures address contour irregularities and aesthetic concerns following autologous breast reconstruction. Mental health diagnoses are known to influence patient satisfaction with reconstruction. The authors aimed to identify oncologic, reconstructive, and demographic factors, including mental health diagnoses, associated with the number of revisions after autologous breast reconstruction. Methods: The medical records of all adult women undergoing abdominal free flap-based breast reconstruction at a major academic institution between 2011 and 2016 were reviewed. Multivariate logistic regression was used to identify factors associated with receipt of revisions. Negative binomial regression was used to identify characteristics associated with number of revisions received. Results: Of 272 patients identified, 55.2 percent received one revision, 23.2 percent received two revisions, and 10.3 percent received three or more revisions after autologous breast reconstruction (median, one; range, zero to five). After adjustment on multivariate analysis, anxiety (OR, 4.34; p = 0.016) and bilateral reconstruction (OR, 3.10; p = 0.017) were associated with receipt of any revisions; other oncologic and reconstructive factors including breast cancer stage, receipt of radiation therapy, and type or timing of free flap reconstruction were not associated with revisions. Using univariate negative binomial regression, anxiety (incidence rate ratio, 1.34; p = 0.006), Caucasian race (incidence rate ratio, 1.24; p = 0.02), and bilateral reconstruction (incidence rate ratio, 1.39; p = 0.04) were predictive of increased numbers of revisions received. After stepwise selection on multivariate analysis, anxiety remained the only significant predictor of increased numbers of revisions. Conclusions: Preoperative anxiety significantly influences the number of revisions after autologous breast reconstruction. Further research is necessary to better understand the interplay among mental health, patient preference, and outcomes in breast reconstruction. Clinical Question/level of Evidence: Risk, III.
Databáze:	MEDLINE
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