Wound healing complications after autologous breast reconstruction: A model to predict risk. Issue 4 (April 2015)

• Record Type: Journal Article
• Authors: Nelson, Jonas A.; Chung, Cyndi U.; Fischer, John P.; Kanchwala, Suhail K.; Serletti, Joseph M.; Wu, Liza C.
• Is Part Of: Journal of plastic, reconstructive & aesthetic surgery. Volume 68:Issue 4(2015:Apr.)
• Page Start: 531
• Page End: 539
• Publication Date: 2015-04
• Subjects: Surgery, Plastic -- Great Britain -- Periodicals; Reconstructive Surgical Procedures -- Periodicals; Surgery, Plastic -- Great Britain -- Periodicals; 617.9505
• DOI: 10.1016/j.bjps.2014.11.017
• Languages: English
• ISSNs: 1748-6815

Abstract

<abstract xml:lang="en" abstract-type="author" id="abs0010"> <title id="sectitle0010">Summary</title> <sec> <title id="sectitle0015">Introduction</title> <p id="abspara0010">Delayed wound healing is costly to the breast reconstruction patient and the health care infrastructure. The purpose of this study is to identify potentially modifiable risk factors and to create a model to assess patient risk of these complications.</p> </sec> <sec> <title id="sectitle0020">Methods</title> <p id="abspara0015">We performed a retrospective study of all free autologous reconstructions at a single institution (2005–2011). Patients with delayed wound healing (operative wounds requiring dressing changes for longer than 3 weeks) were compared to patients with normal healing with respect to history and case characteristics. A risk model was developed to stratify patients based on the multivariate logistic regression results.</p> </sec> <sec> <title id="sectitle0025">Results</title> <p id="abspara0020">Delayed wound healing impacted 297 (44%) of 682 patients. These patients were older (<italic>p</italic> = 0.02), with higher BMI(<italic>p</italic> < 0.0001), and higher rates of medical comorbidities (<italic>p</italic> < 0.001), active smoking (<italic>p</italic> = 0.02) and bilateral reconstruction (<italic>p</italic> = 0.02). They received a lower rate/kg of fluid resuscitation intraoperatively (<italic>p</italic> = 0.001) and more commonly received vasopressors (<italic>p</italic> = 0.004), with a greater total reconstructive cost (<italic>p</italic> = 0.003). A regression demonstrated that progressive obesity, smoking, bilateral reconstruction, and utilization of vasopressors were associated with delayed healing (<italic>p</italic> < 0.05). The final model, with three risk groups (low, intermediate and high) demonstrated that high risk patients have an 86% risk of wound healing complications, compared to a 33% risk in patients with few risk factors.</p> </sec> <sec> <title id="sectitle0030">Conclusions</title> <p id="abspara0025">While patient disease remains a major predictor of wound complications, potentially modifiable variables including smoking and vasopressor administration impacted this complication. Utilizing the simple model to preoperatively assess patient risk, targeted measures can be undertaken with the goal of ultimately reducing wound healing complications and cost.</p> </sec> </abstract>