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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