NSQIP for Monitoring Outcomes after Implant-Based Breast Reconstruction: is it Enough?
Joseph Banuelos, MD, Sharon A. Nehring, RN, BSN, Amjed Abu-ghname, MD, Editt Nikoyan, MS, Jorys Martinez-Jorge, MD, Oscar J. Manrique, MD, Minh-Doan Nguyen, MD, Steven L. Moran, MD, James W. Jakub, MD, Tina J. Hieken, MD, Basel Sharaf, MD, DDS.
Mayo Clinic, Rochester, MN, USA.
Purpose: Implant based breast reconstruction (IBR) accounts for 70% of post-mastectomy breast reconstructions in the United States. Improving the quality of surgical care in IBR patients through accurate measurements of outcomes is necessary. The purpose of this study is to compare data from the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) with our institution's electronic health records database.
Methods: Data was collected and recorded for all patients undergoing IBR at our institution from 2015 to 2017. The data was completely identified and compared with our institutional NSQIP database for demographics and complications.
Results: The electronic health records data search identified 768 IBR patients in three years and NSQIP reported on 229 (30%) patients. Demographics were reported similarly among the 2 databases. Rates of implant infections (6.6% Vs. 1.8%; p=0.003) and wound dehiscence (4.3% Vs. 0.4%; p=0.003) were not reported similarly between our database and NSQIP. However, the rates of hematoma (2.3% Vs. 1.8%) and skin flap necrosis (2.9% Vs. 1.8%) were comparable between the two databases. In our database, 35% of all complications presented after 30 days of surgery.
Conclusions: Databases built on partial sampling, such as the NSQIP, may be useful for demographic analyses, but fall short of providing data for complications following IBR, such as infections and wound dehiscence. These results highlight the utility and importance of complete databases. National comparisons of clinical outcomes for implant-based breast reconstruction should be interpreted with caution when using partial databases.
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