A multi-institutional analysis of a textbook outcome among patients undergoing microvascular breast reconstruction Journal Article
| Authors: | Shammas, R. L.; Hassan, A. M.; Sergesketter, A. R.; Berlin, N. L.; Mirza, H. N.; Guzman, N. M.; Naga, H. I.; Vingan, P.; Govande, J. G.; Silverstein, M. L.; Momeni, A.; Sisk, G. C.; Largo, R. D.; Momoh, A. O.; Nelson, J. A.; Matros, E.; Phillips, B. T. |
| Article Title: | A multi-institutional analysis of a textbook outcome among patients undergoing microvascular breast reconstruction |
| Abstract: | Background Individual outcomes may not accurately reflect the quality of perioperative care. Textbook outcomes (TOs) are composite metrics that provide a comprehensive evaluation of hospital performance and surgical quality. This study aimed to investigate the prevalence and predictors of TOs in a multi-institutional cohort of patients who underwent breast reconstruction with deep inferior epigastric artery perforator flaps. Methods For autologous reconstruction, a TO was previously defined as a procedure without intraoperative complications, reoperation, infection requiring intravenous antibiotics, readmission, mortality, systemic complications, operative duration ≤12 hours for bilateral and ≤10 hours for unilateral/stacked reconstruction, and length of stay (LOS) ≤5 days. We investigated associations between patient-level factors and achieving a TO using multivariable regression analysis. Results Of 1000 patients, most (73.2%) met a TO. The most common reasons for deviation from a TO were reoperation (9.6%), prolonged operative time (9.5%), and prolonged LOS (9.2%). On univariate analysis, tobacco use, obesity, widowed/divorced marital status, and contralateral prophylactic mastectomy or bilateral reconstruction were associated with a lower likelihood of TOs (P < 0.05). After adjustment, bilateral prophylactic mastectomy (odds ratio [OR], 5.71; P = 0.029) and hormonal therapy (OR, 1.53; P = 0.050) were associated with a higher likelihood of TOs; higher body mass index (OR, 0.91; P = <0.001) was associated with a lower likelihood. Conclusion Approximately 30% of patients did not achieve a TO, and the likelihood of achieving a TO was influenced by patient and procedural factors. Future studies should investigate how this metric may be used to evaluate patient and hospital-level performance to improve the quality of care in reconstructive surgery. © Wolters Kluwer Health, Inc. All rights reserved. |
| Keywords: | adult; treatment outcome; middle aged; retrospective studies; clinical trial; perforator flap; breast cancer; mastectomy; breast neoplasms; breast reconstruction; microsurgery; transplantation; vascularization; mammaplasty; retrospective study; postoperative complication; postoperative complications; length of stay; multicenter study; breast tumor; surgery; epidemiology; procedures; epigastric artery; epigastric arteries; humans; human; female; composite measures; textbook outcomes |
| Journal Title: | Annals of Plastic Surgery |
| Volume: | 92 |
| Issue: | 6 Suppl. |
| ISSN: | 0148-7043 |
| Publisher: | Lippincott Williams & Wilkins |
| Date Published: | 2024-06-01 |
| Start Page: | S453 |
| End Page: | S460 |
| Language: | English |
| DOI: | 10.1097/sap.0000000000003950 |
| PUBMED: | 38857013 |
| PROVIDER: | scopus |
| PMCID: | PMC11636357 |
| DOI/URL: | |
| Notes: | Article -- Source: Scopus |
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