Textbook outcomes in DIEP flap breast reconstruction: A Delphi study to establish consensus Journal Article
| Authors: | Shammas, R. L.; Sisk, G. C.; Coroneos, C. J.; Offodile, A. C. 2nd; Largo, R. D.; Momeni, A.; Berlin, N. L.; Hanson, S. E.; Momoh, A. O.; Nelson, J. A.; Matros, E.; Rezak, K.; Phillips, B. T. |
| Article Title: | Textbook outcomes in DIEP flap breast reconstruction: A Delphi study to establish consensus |
| Abstract: | Purpose: Composite measures, like textbook outcomes, may be superior to individual metrics when assessing hospital performance and quality of care. This study utilized a Delphi process to define a textbook outcome in DIEP flap breast reconstruction. Methods: A two-round Delphi survey defined: (1) A textbook outcome, (2) Exclusion criteria for a study population, and (3) Respondent opinion regarding textbook outcomes. An a priori threshold of ≥ 70% agreement among respondents established consensus among the tested statements. Results: Out of 85 invitees, 48 responded in the first round and 41 in the second. A textbook outcome was defined as one that meets the following within 90 days: (1) No intraoperative complications, (2) Operative duration ≤ 12 h for bilateral and ≤ 10 h for unilateral/stacked reconstruction, (3) No post-surgical complications requiring re-operation, (4) No surgical site infection requiring IV antibiotics, (5) No readmission, (6) No mortality, (7) No systemic complications, and (8) Length of stay < 5 days. Exclusion criteria for medical and surgical characteristics (e.g., BMI > 40, HgbA1c > 7) and case-volume cut-offs for providers (≥ 21) and institutions (≥ 44) were defined. Most agreed that textbook outcomes should be defined for complex plastic surgery procedures (75%) and utilized to gauge hospital performance for microsurgical breast reconstruction (77%). Conclusion: This Delphi study identified (1) Key elements of a textbook outcome for DIEP flap breast reconstruction, (2) Exclusion criteria for future studies, and (3) Characterized surgeon opinions regarding the utility of textbook outcomes in serving as quality metric for breast reconstruction care. © 2022, The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature. |
| Keywords: | treatment outcome; retrospective studies; perforator flap; consensus; mastectomy; breast neoplasms; breast reconstruction; mammaplasty; retrospective study; postoperative complication; postoperative complications; breast tumor; delphi study; delphi technique; adverse event; complication; procedures; humans; human; female; composite measures; textbook outcomes |
| Journal Title: | Breast Cancer Research and Treatment |
| Volume: | 197 |
| Issue: | 3 |
| ISSN: | 0167-6806 |
| Publisher: | Springer |
| Date Published: | 2023-02-01 |
| Start Page: | 559 |
| End Page: | 568 |
| Language: | English |
| DOI: | 10.1007/s10549-022-06820-z |
| PUBMED: | 36441271 |
| PROVIDER: | scopus |
| PMCID: | PMC9892240 |
| DOI/URL: | |
| Notes: | Article -- MSK Cancer Center Support Grant (P30 CA008748) acknowledged in PubMed -- Export Date: 1 March 2023 -- Source: Scopus |
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