An Updated Systematic Review and Meta-Analysis of Tissue Oximetry Versus Conventional Methods for Postoperative Monitoring of Autologous Breast Reconstruction.

Autor:	Johnson BM; From the Departments of Plastic Surgery., Egan KG; From the Departments of Plastic Surgery., He J; Biostatistics and Data Science, University of Kansas Medical Center, Kansas City, KS., Lai EC; From the Departments of Plastic Surgery., Butterworth JA; From the Departments of Plastic Surgery.
Jazyk:	angličtina
Zdroj:	Annals of plastic surgery [Ann Plast Surg] 2023 Nov 01; Vol. 91 (5), pp. 617-621. Date of Electronic Publication: 2023 Sep 23.
DOI:	10.1097/SAP.0000000000003705
Abstrakt:	Background: Tissue oximetry monitoring has shown superior outcomes to conventional monitoring methods for autologous breast reconstruction in retrospective studies with consecutive cohorts. A recent study used consecutive cohorts with tissue oximetry as the earlier cohort and found that tissue oximetry was nonsuperior. We hypothesize that improvement in microsurgical outcomes with institutional experience confounds the superiority of tissue oximetry demonstrated in prior studies. This study aimed to perform a systematic review and meta-analysis of the outcomes of tissue oximetry monitoring compared with conventional monitoring. Methods: Relevant studies were found using PubMed, Embase, and Web of Science searches for keywords such as near-infrared spectroscopy or tissue oximetry and microsurgery. Studies included compared tissue oximetry and conventional monitoring in autologous breast reconstruction patients. Studies were excluded if they did not contain a comparison group. Random-effective models were used to analyze early returns to the operating room, the total number of partial or complete flap loss, and late fat necrosis. Results: Six hundred sixty-nine studies were identified; 3 retrospective cohort studies met the inclusion criteria. A total of 1644 flaps were in the tissue oximetry cohort, and 1387 flaps were in the control cohort. One study contained tissue oximetry as the former cohort; 2 had tissue oximetry as the latter. Neither technique was superior for any measured outcomes. The estimated mean differences between tissue oximetry and conventional monitoring method were early returns, -0.06 (95% confidence interval [CI], -0.52 to 0.410; P = 0.82); partial flap loss, -0.04 (95% CI, -0.86 to 0.79; P = 0.93); complete flap loss, -1.29 (95% CI, -3.45 to 0.87; P = 0.24); and late fat necrosis -0.02 (95% CI, -0.42 to, 0.39; P = 0.94). Conclusions: In a systematic review and meta-analysis of mixed timeline retrospective cohort studies, tissue oximetry does not provide superior patient outcomes and shifts our current understanding of postoperative breast reconstruction monitoring. Prospective studies and randomized trials comparing monitoring methods need to be included in the existing literature. Competing Interests: Conflicts of interest and sources of funding: none declared. (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)
Databáze:	MEDLINE
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