Biologic versus synthetic prosthesis for chest wall reconstruction: A matched analysis Journal Article


Authors: Vanstraelen, S.; Bains, M. S.; Dycoco, J.; Adusumilli, P. S.; Bott, M. J.; Downey, R. J.; Huang, J.; Isbell, J. M.; Molena, D.; Park, B. J.; Rusch, V. W.; Sihag, S.; Allen, R. J. Jr; Cordeiro, P. G.; Coriddi, M. R.; Dayan, J. H.; Disa, J. J.; Matros, E.; McCarthy, C. M.; Nelson, J. A.; Stern, C.; Shahzad, F.; Mehrara, B.; Jones, D. R.; Rocco, G.
Article Title: Biologic versus synthetic prosthesis for chest wall reconstruction: A matched analysis
Abstract: OBJECTIVES: The aim of this study was to compare postoperative outcomes between biologic and synthetic reconstructions after chest wall resection in a matched cohort. METHODS: All patients who underwent reconstruction after full-thickness chest wall resection from 2000 to 2022 were reviewed and stratified by prosthesis type (biologic or synthetic). Biologic prostheses were of biologic origin or were fully absorbable and incorporable. Integer matching was performed to reduce confounding. The study end point was surgical site complications requiring reoperation. Multivariable analysis was performed to identify associated risk factors. RESULTS: In total, 438 patients underwent prosthetic chest wall reconstruction (unmatched: biologic, n = 49; synthetic, n = 389; matched: biologic, n = 46; synthetic, n = 46). After matching, the median (interquartile range) defect size was 83 cm2 (50-142) for the biologic group and 90 cm2 (48-146) for the synthetic group (P = 0.97). Myocutaneous flaps were used in 33% of biologic reconstructions (n = 15) and 33% of synthetic reconstructions (n = 15) in the matched cohort (P = 0.99). The incidence of surgical site complications requiring reoperation was not significantly different between biologic and synthetic reconstructions in the unmatched (3 [6%] vs 29 [7%]; P = 0.99) and matched (2 [4%] vs 4 [9%]; P = 0.68) cohorts. On the multivariable analysis, operative time [adjusted odds ratio (aOR) = 1.01, 95% confidence interval (CI), 1.00-1.01; P = 0.006] and operative blood loss (aOR = 1.00, 95% CI, 1.00-1.00]; P = 0.012) were associated with higher rates of surgical site complications requiring reoperation; microvascular free flaps (aOR = 0.03, 95% CI, 0.00-0.42; P = 0.024) were associated with lower rates. CONCLUSIONS: The incidence of surgical site complications requiring reoperation was not significantly different between biologic and synthetic prostheses in chest wall reconstructions. © The Author(s) 2023. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.
Keywords: adult; treatment outcome; aged; middle aged; retrospective studies; major clinical study; postoperative period; postoperative care; follow up; metastasis; pneumonectomy; graft necrosis; retrospective study; risk factor; pneumonia; lung embolism; postoperative complication; postoperative complications; length of stay; operation duration; reoperation; pleura effusion; free tissue graft; myocutaneous flap; hematoma; seroma; wound infection; empyema; wound dehiscence; thorax wall; thoracic wall; radiation necrosis; biological product; biological products; polyglactin; adult respiratory distress syndrome; prostheses and implants; prostheses and orthoses; clindamycin; cefazolin; hematothorax; chest wall resection; thorax wall reconstruction; superinfection; prosthesis infection; operative blood loss; humans; human; male; female; article; postoperative outcomes; 4 hydroxybutyric acid; ecog performance status; chest wall reconstruction; biologic prosthesis; surgical site complications; synthetic prosthesis
Journal Title: European Journal of Cardio-Thoracic Surgery
Volume: 64
Issue: 6
ISSN: 1010-7940
Publisher: Oxford University Press  
Date Published: 2023-12-01
Start Page: ezad348
Language: English
DOI: 10.1093/ejcts/ezad348
PUBMED: 37846030
PROVIDER: scopus
PMCID: PMC11032705
DOI/URL:
Notes: Article -- MSK Cancer Center Support Grant (P30 CA008748) acknowledged in PubMed and PDF -- MSK corresponding author is Gaetano Rocco -- Source: Scopus
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MSK Authors
  1. Valerie W Rusch
    869 Rusch
  2. Joseph Disa
    265 Disa
  3. Carrie Stern
    43 Stern
  4. Babak Mehrara
    454 Mehrara
  5. James Huang
    215 Huang
  6. Peter G Cordeiro
    288 Cordeiro
  7. Evan Matros
    207 Matros
  8. Bernard J Park
    265 Park
  9. Matthew Bott
    136 Bott
  10. Colleen Marie McCarthy
    144 McCarthy
  11. Robert J Downey
    254 Downey
  12. Joseph Dycoco
    46 Dycoco
  13. Manjit S Bains
    338 Bains
  14. David Randolph Jones
    418 Jones
  15. Daniela   Molena
    276 Molena
  16. Joseph Henry Dayan
    101 Dayan
  17. Robert J Allen Jr
    101 Allen Jr
  18. James Michael Isbell
    127 Isbell
  19. Jonas Allan Nelson
    217 Nelson
  20. Smita Sihag
    98 Sihag
  21. Michelle Renee Coriddi
    62 Coriddi
  22. Gaetano Rocco
    132 Rocco
  23. Farooq Shahzad
    38 Shahzad