Improved Operative Efficiency and Surgical Times in Autologous Breast Reconstruction: A 15-year Single-center Retrospective Review.

Autor:	Todd AR; From the Section of Plastic and Reconstructive Surgery, University of Calgary, Calgary, Alberta, Canada., Genereux O; From the Section of Plastic and Reconstructive Surgery, University of Calgary, Calgary, Alberta, Canada., Schrag C; From the Section of Plastic and Reconstructive Surgery, University of Calgary, Calgary, Alberta, Canada., Hatchell A; From the Section of Plastic and Reconstructive Surgery, University of Calgary, Calgary, Alberta, Canada., Matthews J; From the Section of Plastic and Reconstructive Surgery, University of Calgary, Calgary, Alberta, Canada.
Jazyk:	angličtina
Zdroj:	Plastic and reconstructive surgery. Global open [Plast Reconstr Surg Glob Open] 2023 Sep 15; Vol. 11 (9), pp. e5231. Date of Electronic Publication: 2023 Sep 15 (Print Publication: 2023).
DOI:	10.1097/GOX.0000000000005231
Abstrakt:	Background: Autologous breast reconstruction using a free deep inferior epigastric perforator (DIEP) flap is a complex procedure that requires a dedicated approach to achieve operative efficiency. We analyzed data for DIEP flaps at a single center over 15 years to identify factors contributing to operative efficiency. Methods: A single-center, retrospective cohort analysis was performed of consecutive patients undergoing autologous breast reconstruction using DIEP free flaps between January 1, 2005, and December 31, 2019. Data were abstracted a priori from electronic medical records. Analysis was conducted by a medical statistician. Results: Analysis of 416 unilateral and 320 bilateral cases (1056 flaps) demonstrated reduction in operative times from 2005 to 2019 (11.7-8.2 hours for bilateral and 8.4-6.2 hours for unilateral, P < 0.000). On regression analysis, factors significantly correlating with reduced operative times include the use of venous couplers ( P < 0.000), and the internal mammary versus the thoracodorsal recipient vessels ( P < 0.000). Individual surgeon experience correlated with reduced OR times. Post-operative length of stay decreased significantly, without an increase in 30-day readmission or emergency presentations. Flap failure occurred in two cases. Flap take-back rate was 2% (n = 23) with no change between 2005 and 2019. Conclusions: Operative times for breast reconstruction have decreased significantly at this center over 15 years. The introduction of venous couplers, use of the internal mammary system, and year of surgery significantly correlated with decreased operative times. Surgeon experience and a shift in surgical workflow for DIEP flap reconstruction likely contributed to the latter finding. Competing Interests: The authors have no financial interest to declare in relation to the content of this article. Disclosure statements are at the end of this article, following the correspondence information. (Copyright © 2023 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The American Society of Plastic Surgeons.)
Databáze:	MEDLINE
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