Can Surgical Technique Impact Length of Stay and Post-Operative Outcomes in Breast Reconstruction?
Allen Gabriel, MD, FACS1, Steven Sigalove, MD, FACS2, Noemi Sigalove, MD3, Toni Storm Dickerson, MD4, Jami Rice, PA5, G. Patrick Maxwell, MD, FACS1, Leah Griffin, MS6, Mousam Parekh, MS7, David Macarios, MS, MBA7.
1Loma Linda University, Loma Linda, CA, USA, 2DuPage Medical Group/DMG Aesthetics, Winfield, IL, USA, 3Central DuPage Hospital/Northwestern Medicine, Winfield, IL, USA, 4Compass Oncology, Vancouver, WA, USA, 5PeaceHealth Plastic Surgery, Vancouver, WA, USA, 6Acelity, San Antonio, TX, USA, 7Acelity, Bridgewater, NJ, USA.
PURPOSE: Pre-pectoral breast reconstruction is a less invasive technique that shows promise in improving patient outcomes. This study compares hospital length of stay (LOS) and post-operative outcomes of pre-pectoral (PP) and dual plane (DP) techniques of breast reconstruction.
METHODS: This single-site, retrospective cohort study included data from breast reconstruction procedures from June 2013 to March 2016. Data collected included demographics, chemotherapy/radiation exposure, surgical technique, LOS, drain usage, post-operative incision care and 90 day post-operative complications. Two-sided T-test and Chi-square or Fisher’s Exact tests were performed at α = 0.05.
RESULTS: The study included data on 176 patients (DP=117, PP=59) and 335 breasts (DP=225, PP=110). The PP group had significantly higher BMI (p=0.0017), and a significantly higher proportion of patients with diabetes (p=0.0073), hypertension (p=0.0061), and prior breast surgery (p=0.0415). A higher proportion of PP patient received incisional negative pressure wound therapy (p<0.0001) for incision care. There were no differences in complication rates between the two groups. The PP group had a significantly lower LOS compared to DP (mean: 1.1 vs. 1.8 days, p<0.0001). In the PP group, 94.9% patients were discharged after 1 hospital day compared to only 25.6% of the DP patients (p<0.0001).
CONCLUSION: This study demonstrated a significantly lower hospital LOS in the PP group compared to DP technique. Complication rates were similar between the two groups even though the PP group was more complex. Studies with a long-term follow up will be critical in understanding the true differences between surgical technique and clinical outcomes.
Table: Complication rates across surgery types (breast-level)
|DP N = 225 n (%)||PP N = 110 n (%)||p-value|
|Any complication||22 (9.8%)||14 (12.7%)||0.4130|
|Surgical site infection||11 (4.9%)||2 (1.8%)||0.2343|
|Dehiscence||7 (3.1%)||6 (5.5%)||0.3672|
|Necrosis||9 (4.0%)||10 (9.1%)||0.0771|
|Seroma||7 (3.1%)||3 (2.7%)||1.0000|
|Hematoma||7 (3.1%)||3 (2.7%)||1.0000|
|Tissue expander exposure||3 (1.3%)||1 (0.9%)||1.0000|
|Return to operating room||10 (4.4%)||4 (3.6%)||1.0000|
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