Predicting Complications in Immediate Alloplastic Breast Reconstruction: How Useful Is the American College of Surgeons National Surgical Quality Improvement Program Surgical Risk Calculator?

OʼNeill, Anne C.; Murphy, Brian; Bagher, Shaghayegh; Qahtani, Saad Al; Höfer, Stefan; Zhong, Toni

doi:10.1097/prs.0000000000003051

Cited by 11 publications

(10 citation statements)

References 28 publications

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“…In addition, this particular population poses a challenge due to longer operative time and technical difficulties [74]. Our findings comply with previous studies on the association between obesity and increased risk of postoperative complications, including seroma, infection and reconstructive failure [32,74,75,76,77]. In addition, our analysis showed that the odds of complications increased 8.1% for each unit increase in a patient’s BMI.…”

Section: Discussionsupporting

confidence: 91%

Two-Staged Implant-Based Breast Reconstruction: A Long-Term Outcome Study in a Young Population

et al. 2019

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Background and objectives: Differences in patient anatomy and physiology exist between young and older patients undergoing breast reconstruction after mastectomy. Breast cancer has been described as being more aggressive, more likely to receive radiation, contralateral mastectomy, as well as bilateral reconstruction in young patients. Our purpose is to report long-term experience on two-staged implant-based breast reconstruction (IBR) in young females, with complication sub-analysis based on obesity and adjuvant radiation. Materials and Methods: Retrospective chart review of all consecutive young patients who underwent two-staged IBR at our institution, between 2000 and 2016, was performed. Patients between 15 and 40 years old with least 1-year follow-up were included. Univariate logistic regression models and receiver operating characteristic (ROC) curves were created. Results: Overall 594 breasts met our inclusion criteria. The mean age was 34 years, and the median follow-up was 29.6 months. Final IBR was achieved in 98% of breasts. Overall, 12% of breasts had complications, leading to explantations of 5% of the devices. Adjuvant radiation was followed by higher rates of total device explantations (p = 0.003), while obese patients had higher rates of total complications (p < 0.001). For each point increase in BMI, the odds of developing complications increased 8.1% (p < 0.001); the cutoff BMI to predict higher complications was 24.81 kg/m2. Conclusions: This population demonstrates high successful IBR completion and low explantation rates. These data suggest that obese women and those with planned adjuvant radiation deserve special counseling about their higher risk of complications.

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Section: Discussionsupporting

confidence: 91%

Two-Staged Implant-Based Breast Reconstruction: A Long-Term Outcome Study in a Young Population

et al. 2019

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“…A keen understanding of the patient populations within each registry is vital to making inferences about surgical outcomes. 12 , 19 , 28 – 30 The TOPS and NSQIP databases are 2 robust national databases that can be used for plastic surgery outcomes. Our results demonstrate that the TOPS and NSQIP databases have differing patient populations, which must be understood when using the data for analysis.…”

Section: Discussionmentioning

confidence: 99%

“…However, the NSQIP lacks complication reporting for many specific outcomes of interest for plastic surgeons, such as loss of graft, flap, or prosthesis. 12 The TOPS database is designed to track 30-day surgical outcomes for plastic surgery patients, specifically. Implemented initially in 2002, TOPS is contributed to by over 700 ASPS member surgeons across the United States.…”

Section: Methodsmentioning

confidence: 99%

“…A large body of work in plastic surgery has used the American College of Surgeons—National Surgical Quality Improvement Program (NSQIP) database. 12 – 18 An alternative database, the American Society of Plastic Surgeons (ASPS)—Tracking Operations and Outcomes for Plastic Surgeons (TOPS) has recently been considered for outcomes research specifically in plastic surgery but has a less well-understood patient population. 19 , 20 …”

Section: Introductionmentioning

confidence: 99%

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A Comparison of Common Plastic Surgery Operations Using the NSQIP and TOPS Databases

Veith

Collier

Simpson

et al. 2020

Plastic and Reconstructive Surgery - Global Open

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“…6,36,37 However, validation studies examining the predictive utility of this tool in the surgical subspecialties have yielded mixed results. 6,38,39 In two individual studies identified in this review, O’Neill et al examined the predictive capacity of the ACS/NSQIP calculator in both autologous and expander/implant-based breast reconstruction patients. 6,26 In autologous reconstruction, the authors found that this tool was relatively accurate in predicting the proportion of patients within the cohort that would develop a complication (14% predicted versus 11.1% actual), but was very poor at distinguishing individual patients who were likely to develop a complication ( c -statistic 0.55).…”

Section: Discussionmentioning

confidence: 99%

An Ounce of Prediction is Worth a Pound of Cure: Risk Calculators in Breast Reconstruction

Oleck

Keshri

Shammas

et al. 2022

Plastic and Reconstructive Surgery - Global Open

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Background: Preoperative risk calculators provide individualized risk assessment and stratification for surgical patients. Recently, several general surgery-derived models have been applied to the plastic surgery patient population, and several plastic surgery-specific calculators have been developed. In this scoping review, the authors aimed to identify and critically appraise risk calculators implemented in postmastectomy breast reconstruction. Methods: A systematic review of the literature was conducted. Included studies described the development of a novel risk calculator, or validation of an existing calculator, in postmastectomy breast reconstruction. Results: In total, 4641 studies met criteria for title and abstract screening. Fortyseven were eligible for full-text review, and 28 met final inclusion criteria. The most common risk calculators included the Breast Reconstruction Risk Assessment score (n = 6 studies), modified frailty index (n = 3), Caprini score (n = 3), and ACS NSQIP calculator (n = 2). Calculators were applied to institutional data (n = 17), NSQIP (n = 6), and Tracking Outcomes in Plastic Surgery (n = 1) databases. Predicted outcomes included general postoperative complications (n = 17), venous thromboembolism/pulmonary embolism (n = 4), infection (n = 2), and patient reported outcomes (n = 2). Model accuracy was reported in 18 studies, and it varied significantly (accurate risk calculator 0.49-0.85). Conclusions: This is the first study to provide a systematic review of available risk calculators for breast reconstruction. Models vary significantly in their statistical basis, predicted outcomes, and overall accuracy. Risk calculators are valuable tools that may aid in individualized risk assessments, preoperative counseling, and expectation management in breast reconstruction.

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Predicting Complications in Immediate Alloplastic Breast Reconstruction: How Useful Is the American College of Surgeons National Surgical Quality Improvement Program Surgical Risk Calculator?

Cited by 11 publications

References 28 publications

Two-Staged Implant-Based Breast Reconstruction: A Long-Term Outcome Study in a Young Population

Two-Staged Implant-Based Breast Reconstruction: A Long-Term Outcome Study in a Young Population

A Comparison of Common Plastic Surgery Operations Using the NSQIP and TOPS Databases

An Ounce of Prediction is Worth a Pound of Cure: Risk Calculators in Breast Reconstruction

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