Latissimus dorsi flap versus pedicled transverse rectus abdominis myocutaneous breast reconstruction

Outcomes

Laura F. Teisch, David J. Gerth, Jun Tashiro, Samuel Golpanian, Seth Thaller

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Background Pedicled breast reconstruction is a mainstay treatment for plastic surgeons. Although indications vary for each breast reconstruction technique, there exist some overlapping characteristics that may determine a successful outcome. We aimed to determine the impact flap selection has on postoperative outcomes and resource utilization. Materials and methods Nationwide Inpatient Sample database (2010-2011) was reviewed for cases of latissimus dorsi (LD; International Classification of Diseases, Ninth Revision, Clinical Modification, 85.71) and pedicled transverse rectus abdominis myocutaneous (pTRAM; 85.72) breast reconstruction. Males were excluded. Demographic, socioeconomic, clinical factors, postoperative complications, length of stay (LOS), and total charges (TC) were assessed. Chi-squared and multivariate analyses were performed to identify independent risk factors of resource utilization and postoperative complications. Results A total of 29,074 cases were identified; 17,670 (61%) LD and 11,405 (39%) pTRAM. 74% percent were Caucasian, 94% insured, and 66% were treated in teaching hospitals. There were 24 mortalities (15 LD, 9 pTRAM). LD patients were more likely to be obese (odds ratio [OR] = 1.3), suffer from flap loss (OR = 1.4), wound infection (OR = 1.6), wound dehiscence (OR = 2.2), and hematoma (OR = 1.3), P <0.05. Patients undergoing pTRAM were more likely to undergo surgical revision (OR = 6.9), suffer from systemic infection (OR = 1.8), pneumonia (OR = 5.0), or pulmonary embolism (OR = 29.2), P <0.05. Risk-adjusted multivariate analysis demonstrated LD was an independent risk factor for postoperative complication (OR = 1.4) and increased TC (OR = 1.3), P <0.001. Conversely, undergoing pTRAM was an independent risk factor for increased LOS (OR = 6.3), P <0.001. Conclusions Analysis of a national database found LD breast reconstruction to have higher TC and increased risk for surgical site complications. Patients undergoing pTRAM had increased risk for pulmonary complications and LOS. Procedure selection may be refined as additional characteristics are discovered using outcomes-based research.

Original languageEnglish (US)
Pages (from-to)274-279
Number of pages6
JournalJournal of Surgical Research
Volume199
Issue number1
DOIs
StatePublished - Nov 1 2015

Fingerprint

Rectus Abdominis
Surgical Flaps
Superficial Back Muscles
Mammaplasty
Odds Ratio
Length of Stay
Multivariate Analysis
Databases
International Classification of Diseases
Wound Infection
Pulmonary Embolism
Reoperation
Teaching Hospitals
Hematoma
Inpatients
Pneumonia

Keywords

  • Autologous breast reconstruction
  • Cost utilization
  • Latissimus dorsi flap
  • Length of stay
  • Pedicled TRAM flap
  • Postoperative complications

ASJC Scopus subject areas

  • Surgery

Cite this

Latissimus dorsi flap versus pedicled transverse rectus abdominis myocutaneous breast reconstruction : Outcomes. / Teisch, Laura F.; Gerth, David J.; Tashiro, Jun; Golpanian, Samuel; Thaller, Seth.

In: Journal of Surgical Research, Vol. 199, No. 1, 01.11.2015, p. 274-279.

Research output: Contribution to journalArticle

Teisch, Laura F. ; Gerth, David J. ; Tashiro, Jun ; Golpanian, Samuel ; Thaller, Seth. / Latissimus dorsi flap versus pedicled transverse rectus abdominis myocutaneous breast reconstruction : Outcomes. In: Journal of Surgical Research. 2015 ; Vol. 199, No. 1. pp. 274-279.
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T2 - Outcomes

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AU - Gerth, David J.

AU - Tashiro, Jun

AU - Golpanian, Samuel

AU - Thaller, Seth

PY - 2015/11/1

Y1 - 2015/11/1

N2 - Background Pedicled breast reconstruction is a mainstay treatment for plastic surgeons. Although indications vary for each breast reconstruction technique, there exist some overlapping characteristics that may determine a successful outcome. We aimed to determine the impact flap selection has on postoperative outcomes and resource utilization. Materials and methods Nationwide Inpatient Sample database (2010-2011) was reviewed for cases of latissimus dorsi (LD; International Classification of Diseases, Ninth Revision, Clinical Modification, 85.71) and pedicled transverse rectus abdominis myocutaneous (pTRAM; 85.72) breast reconstruction. Males were excluded. Demographic, socioeconomic, clinical factors, postoperative complications, length of stay (LOS), and total charges (TC) were assessed. Chi-squared and multivariate analyses were performed to identify independent risk factors of resource utilization and postoperative complications. Results A total of 29,074 cases were identified; 17,670 (61%) LD and 11,405 (39%) pTRAM. 74% percent were Caucasian, 94% insured, and 66% were treated in teaching hospitals. There were 24 mortalities (15 LD, 9 pTRAM). LD patients were more likely to be obese (odds ratio [OR] = 1.3), suffer from flap loss (OR = 1.4), wound infection (OR = 1.6), wound dehiscence (OR = 2.2), and hematoma (OR = 1.3), P <0.05. Patients undergoing pTRAM were more likely to undergo surgical revision (OR = 6.9), suffer from systemic infection (OR = 1.8), pneumonia (OR = 5.0), or pulmonary embolism (OR = 29.2), P <0.05. Risk-adjusted multivariate analysis demonstrated LD was an independent risk factor for postoperative complication (OR = 1.4) and increased TC (OR = 1.3), P <0.001. Conversely, undergoing pTRAM was an independent risk factor for increased LOS (OR = 6.3), P <0.001. Conclusions Analysis of a national database found LD breast reconstruction to have higher TC and increased risk for surgical site complications. Patients undergoing pTRAM had increased risk for pulmonary complications and LOS. Procedure selection may be refined as additional characteristics are discovered using outcomes-based research.

AB - Background Pedicled breast reconstruction is a mainstay treatment for plastic surgeons. Although indications vary for each breast reconstruction technique, there exist some overlapping characteristics that may determine a successful outcome. We aimed to determine the impact flap selection has on postoperative outcomes and resource utilization. Materials and methods Nationwide Inpatient Sample database (2010-2011) was reviewed for cases of latissimus dorsi (LD; International Classification of Diseases, Ninth Revision, Clinical Modification, 85.71) and pedicled transverse rectus abdominis myocutaneous (pTRAM; 85.72) breast reconstruction. Males were excluded. Demographic, socioeconomic, clinical factors, postoperative complications, length of stay (LOS), and total charges (TC) were assessed. Chi-squared and multivariate analyses were performed to identify independent risk factors of resource utilization and postoperative complications. Results A total of 29,074 cases were identified; 17,670 (61%) LD and 11,405 (39%) pTRAM. 74% percent were Caucasian, 94% insured, and 66% were treated in teaching hospitals. There were 24 mortalities (15 LD, 9 pTRAM). LD patients were more likely to be obese (odds ratio [OR] = 1.3), suffer from flap loss (OR = 1.4), wound infection (OR = 1.6), wound dehiscence (OR = 2.2), and hematoma (OR = 1.3), P <0.05. Patients undergoing pTRAM were more likely to undergo surgical revision (OR = 6.9), suffer from systemic infection (OR = 1.8), pneumonia (OR = 5.0), or pulmonary embolism (OR = 29.2), P <0.05. Risk-adjusted multivariate analysis demonstrated LD was an independent risk factor for postoperative complication (OR = 1.4) and increased TC (OR = 1.3), P <0.001. Conversely, undergoing pTRAM was an independent risk factor for increased LOS (OR = 6.3), P <0.001. Conclusions Analysis of a national database found LD breast reconstruction to have higher TC and increased risk for surgical site complications. Patients undergoing pTRAM had increased risk for pulmonary complications and LOS. Procedure selection may be refined as additional characteristics are discovered using outcomes-based research.

KW - Autologous breast reconstruction

KW - Cost utilization

KW - Latissimus dorsi flap

KW - Length of stay

KW - Pedicled TRAM flap

KW - Postoperative complications

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