The Impact of Race on Perioperative and Patient-Reported Outcomes following Autologous Breast Reconstruction

Oskar, Sabine; Nelson, Jonas A.; Hicks, Madeleine E. V.; S, Kenneth P Seier M; Tan, Kay See; Chu, Jacqueline J.; West, S.L.; Allen, Robert J.; Barrio, Andrea V.; Matros, Evan; Afonso, Anoushka M.

doi:10.1097/prs.0000000000008633

Cited by 13 publications

(6 citation statements)

References 43 publications

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“…Notably, secondary significant predictors of postoperative complications were also identified after microsurgical cases. These relationships have been upheld by previous studies, which have detected associations of microsurgery complications with demographic characteristics, 35 36 37 comorbidity history, 38 39 40 and perioperative variables. 41 42 43 These variables also had varying patterns of associations across different temporal periods; for example, BMI and race appeared to have a differential effect on complication depending on period, as White race and higher BMI protected against risk of complication in the first week but then significantly predicted higher risk in later periods.…”

Section: Discussionmentioning

confidence: 94%

When a Good Flap Turns Bad: A Temporal Predictive Model for Free Flap Complications

Kim,

Aschen,

Rohde

2024

J Reconstr Microsurg

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Background Microsurgical cases are complex plastic surgery procedures with a significant risk of acute postoperative complications. In this study, we use a large-scale database to investigate the temporal progression of complications after microsurgical procedures and the risk imparted by acute postoperative complications on subsequent reconstructive outcomes. Methods Microsurgery cases were extracted from the National Surgical Quality Improvement Program database by Current Procedural Terminology codes. Postoperative complications were collected for 30 days after surgery and stratified into four temporal periods (postoperative days [PODs] 0–6, 7–13, 14–20, 21–30). Postoperative complication occurrences were incorporated into a weighted multivariate logistic regression model to identify significant predictors of adverse outcomes (p < 0.05). Separately, a regression model was calculated for the time between index operation and reoperation and additional complications. Results The final cohort comprised 19,517 patients, 6,140 (31.5%) of which experienced at least one complication in the first 30 days after surgery. The occurrence of prior complications in the postoperative period was a significant predictor of future adverse outcomes following the initial week after surgery (p < 0.001). Upon predictive analysis, overall model performance was highest in PODs 7 to 13 (71.1% accuracy and the area under a receiver operating characteristic curve 0.684); 2,578 (13.2%) patients underwent at least one reoperation within the first 2 weeks after surgery. The indication for reoperation (p < 0.001) and number of days since surgery (p = 0.0038) were significant predictors of future complications after reoperation. Conclusion Prior occurrence of complications in an earlier postoperative week, as well as timing and nature of reoperation, were shown to be significant predictors of future complications.

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Section: Discussionmentioning

confidence: 94%

When a Good Flap Turns Bad: A Temporal Predictive Model for Free Flap Complications

Kim,

Aschen,

Rohde

2024

J Reconstr Microsurg

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“…When comparing patients who underwent reconstruction of the LE, African American race proved to be associated with higher risk of reoperation ( P = 0.05) when controlling for other potentially confounding risk factors. Recently, Oskar et al 31 found that African Americans patients had a higher incidence of 30-day major complications and were more likely to return to the operating room after autologous breast free flap reconstruction. Likewise, our group found that African American race was an independent risk factor for unplanned reoperation in patients undergoing head and neck free flap reconstruction 26 .…”

Section: Discussionmentioning

confidence: 99%

Timing of Unplanned Reoperation After Lower Extremity Free Flap Reconstruction

et al. 2023

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Background Advancements in lower extremity (LE) microsurgery have allowed for the expansion of indications for LE reconstructions. This project aims to better understand the temporal pattern and risk factors associated with LE free flap failure based on the clinical indication. Materials and Methods We analyzed all patients undergoing LE free flap reconstruction from the American College of Surgeons National Surgical Quality Improvement Program 2012–2019 prospectively collected data to determine rates and timing of reoperation. Free flaps were stratified by indication, type, and timing of reoperation. Weibull survival models were used to compare rates of takebacks among time intervals. Multivariable logistic regression was used to identify independent predictors for unplanned reoperation. Results Four hundred seven of LE free flaps were analyzed. There was a 14.5% rate (59/407) of unplanned reoperation within the first 30 postoperative days (PODs) after surgery. When stratified by the indication necessitating reoperation, patients with an underlying vascular indication had the highest rate of reoperation (40.9%). The reoperation rates were significantly different between indications (P < 0.05) The mean daily proportion of patients experiencing reoperation was highest during POD 0 to 2 (1.47% reoperations per day), which dropped significantly during POD 3 to 10 (0.55% per day) and again during POD 11 to 30 (0.28% per day, P < 0.05). African American race as well as malignant, prosthetic/implant, and wound/infectious indications were significant independent predictors for unplanned reoperation. Conclusions Lower extremity reconstruction is an important reconstructive option for the coverage of a myriad of defects. Understanding the differences between postoperative reoperation timelines among indication subtypes is important for updated flap monitoring protocols, optimizing ERAS pathways, and beginning dangle protocols.

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“…16 Previous studies have demonstrated sociodemographic inequities in patient selection and surgical outcomes following ABR, dating back prior to the pandemic. [17][18][19][20][21] In conjunction with the aforementioned challenges presented by the global pandemic, it is critical to assess the effects that these challenges have had on ABR outcomes and whether the pandemic has exacerbated previous inequities or created new ones. To this end, our study aimed to assess whether the challenges imposed by the pandemic have led to differences in patient selection, hospital course and severity, and postoperative complications for patients who underwent ABR using the ACS-NSQIP, a nationally representative and validated database.…”

Section: Discussionmentioning

confidence: 99%

Trends of Autologous Free-Flap Breast Reconstruction and Safety during the Coronavirus Disease 2019 Pandemic

Elmer

Bustos

Veeramani

et al. 2023

J Reconstr Microsurg

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Background: Autologous free flap breast reconstruction (ABR) is a valuable surgical option for patients following mastectomy. The COVID-19 pandemic has led to a myriad of factors that have affected access to care, hospital logistics, and post-operative outcomes. This study aims to identify differences in patient selection, hospital course and severity, and post-operative outcomes for patients who underwent ABR during and prior to the COVID-19 pandemic. Methods: Patients undergoing ABR from the ACS-NSQIP 2019-2020 database were analyzed to compare sociodemographics, hospital course, and outcomes over the first post-operative month. Multivariable logistic regression was used to identify factors predictive of complications based on operative year. Results: 3,770 breast free flaps were stratified into two groups based on the timing of reconstruction (pre-pandemic and pandemic groups). Patients with a diagnosis of disseminated cancer were significantly less likely to undergo ABR during the COVID-19 pandemic. On univariate analysis, there were no significant differences in post-operative complications between the two groups. When controlling for potentially confounding sociodemographic and clinical risk factors, the COVID-19 group was significantly more likely to undergo reoperation compared to the pre-pandemic group (p< 0.05). Conclusion: When comparing outcomes for patients who underwent ABR prior to and during the COVID-19 pandemic, we found a significant increase in the odds of reoperation for those who had ABR during the pandemic. Debridement procedures and exploration for postoperative hemorrhage, thrombosis or infection increased from the pre-pandemic group to the COVID-19 group. Notably, operative times decreased.

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The Impact of Race on Perioperative and Patient-Reported Outcomes following Autologous Breast Reconstruction

Cited by 13 publications

References 43 publications

When a Good Flap Turns Bad: A Temporal Predictive Model for Free Flap Complications

When a Good Flap Turns Bad: A Temporal Predictive Model for Free Flap Complications

Timing of Unplanned Reoperation After Lower Extremity Free Flap Reconstruction

Trends of Autologous Free-Flap Breast Reconstruction and Safety during the Coronavirus Disease 2019 Pandemic

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