20 Years of DIEAP Flap Breast Reconstruction: A Big Data Analysis

Abstract

With every hospital admission, a vast amount of data is collected from every patient. Big data can help in data mining and processing of this volume of data. The goal of this study is to investigate the potential of big data analyses by analyzing clinically relevant data from the immediate postoperative phase using big data mining techniques. A second aim is to understand the importance of different postoperative parameters. We analyzed all data generated during the admission of 739 women undergoing a free DIEAP flap breast reconstruction. The patients’ complete midcare nursing report, laboratory data, operative reports and drug schedule were examined (7,405,359 data points). The duration of anesthesia does not predict the need for revision. Low Red Blood cell Counts (3.53 × 106/µL versus 3.79 × 106/µL, p < 0.001) and a low MAP (MAP = 73.37 versus 76.62; p < 0.001) postoperatively are correlated with significantly more revisions. Different drugs (asthma/COPD medication, Butyrophenones) can also play a significant role in the success of the free flap. In a world that is becoming more data driven, there is a clear need for electronic medical records which are easy to use for the practitioner, nursing staff, and the researcher. Very large datasets can be used, and big data analysis allows a relatively easy and fast interpretation all this information.

Predictive risk factors of complications in different breast reconstruction methods

“…Variables independently associated with complications in this study included also a history of asthma or chronic obstructive pulmonary disease. This is in line with earlier studies [16,18] with free flaps and mastectomy combined with implant or muscular flap reconstruction [17]. In those studies, a significant correlation was found between COPD/ asthma and the need for revision surgery.…”

“…There are many studies evaluating postoperative complications and comorbidities associated with breast reconstructions [11][12][13][14][15][16][17][18], but only few have assessed the predictive risk factors for postoperative complications. It is common that only one or two surgical techniques are compared to or the follow-up time is 30 days postoperatively [14,19,20].…”

Overall Complication Rates of DIEP Flap Breast Reconstructions in Germany—A Multi-Center Analysis Based on the DGPRÄC Prospective National Online Registry for Microsurgical Breast Reconstructions

“…The descriptive data and demographical variables of the investigated study population were comparable to international literature. For example, in our study the mean age of patients receiving DIEP flap transfer was 51.3 years, compared to a median age of 51.6 years in the study population investigated by Kamali et al [ 16 ] and 46.7 years in the study population evaluated by Depypere et al [ 31 ]. Mean BMI was 26.28 kg/m 2 and therefore slightly higher in comparison to the population investigated Vanschoonbeek et al (24.9 kg/m 2 ) [ 32 ] and almost equal to the mean BMI of the study population investigated by Unukovych et al (26.2 kg/m 2 ) [ 30 ].…”

“…Overall, the presented data show that free DIEP transfer for breast reconstruction is performed under high quality standards over a broad number of centers in Germany, with total and partial flap loss rates as low as 2.0% and 1.1% respectively, and emergent vascular revision surgery being performed in 4.3% of cases. The outcome and complication rates deduced from the national registry compare to recent large-scale international studies and show no significant disparity in this regard [29][30][31][32]. The study population of Vemula et al (478 DIEP flaps) showed overall DIEP flap success rates of 98.2% at specialty surgery hospitals and 96.4% at tertiary care facilities [29].…”

“…Mirroring our results, flap failure was encountered in 2.0% of cases, while partial flap loss was found in 1.2% of all cases [ 30 ]. Depypere et al report revision surgery in 5% (48/965) of all DIEP flaps investigated [ 31 ]. The study group of Vanschoonbeek et al investigated a total of 1330 DIEP free flaps, of which 3.38% required urgent exploration.…”