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Risk of major postoperative complications in breast reconstructive surgery with and without an acellular dermal matrix: A development of a prognostic prediction model

INTRODUCTION: Acellular dermal matrices (ADM) have been suggested to allow for different approaches and reduce the risk of postoperative complications in implant-based breast surgery. Surgeons seem to embrace ADMs around the world, although a lack of consistent evidence regarding the factors that in...

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Autores principales: Hillberg, N.S., Hogenboom, J., Hommes, J., Van Kuijk, S.M.J., Keuter, X.H.A., van der Hulst, R.R.W.J.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9260237/
https://www.ncbi.nlm.nih.gov/pubmed/35812357
http://dx.doi.org/10.1016/j.jpra.2022.04.007
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author Hillberg, N.S.
Hogenboom, J.
Hommes, J.
Van Kuijk, S.M.J.
Keuter, X.H.A.
van der Hulst, R.R.W.J.
author_facet Hillberg, N.S.
Hogenboom, J.
Hommes, J.
Van Kuijk, S.M.J.
Keuter, X.H.A.
van der Hulst, R.R.W.J.
author_sort Hillberg, N.S.
collection PubMed
description INTRODUCTION: Acellular dermal matrices (ADM) have been suggested to allow for different approaches and reduce the risk of postoperative complications in implant-based breast surgery. Surgeons seem to embrace ADMs around the world, although a lack of consistent evidence regarding the factors that increase the risk of major postoperative complications remains. PURPOSE: To develop and internally validate a model to predict the risk of a major postoperative complication in breast reconstructive surgery with and without an ADM. METHODOLOGY: The DBIR is an opt-out registry that holds characteristics of all breast implant surgeries in the Netherlands since 2015. Using a literature-driven preselection of predictors, multivariable mixed-effects logistic regression modelling was used to develop the prediction model. RESULTS: A total of 2939 breasts were eligible, of which 11% underwent an ADM-assisted procedure (single-stage or two-stage). However, 31% underwent a two-stage procedure (with or without the use of ADM). Of all breasts, 10.2% developed a major postoperative complication. Age (OR 1.01), delayed timing (OR 0.71), and two-stage technique (OR 4.46) were associated with the outcome. CONCLUSION: The data suggest that ADM use was not associated with a major postoperative complication, while two-stage reconstructions were strongly associated with an increased risk of major complications. Despite these findings, ADMs are not as popular in the Netherlands as in the USA. The predictive capabilities of the developed model are mediocre to poor, but because of the above findings, we believe that the role of the two-stage technique as a golden standard should be put up for debate.
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spelling pubmed-92602372022-07-08 Risk of major postoperative complications in breast reconstructive surgery with and without an acellular dermal matrix: A development of a prognostic prediction model Hillberg, N.S. Hogenboom, J. Hommes, J. Van Kuijk, S.M.J. Keuter, X.H.A. van der Hulst, R.R.W.J. JPRAS Open Original Article INTRODUCTION: Acellular dermal matrices (ADM) have been suggested to allow for different approaches and reduce the risk of postoperative complications in implant-based breast surgery. Surgeons seem to embrace ADMs around the world, although a lack of consistent evidence regarding the factors that increase the risk of major postoperative complications remains. PURPOSE: To develop and internally validate a model to predict the risk of a major postoperative complication in breast reconstructive surgery with and without an ADM. METHODOLOGY: The DBIR is an opt-out registry that holds characteristics of all breast implant surgeries in the Netherlands since 2015. Using a literature-driven preselection of predictors, multivariable mixed-effects logistic regression modelling was used to develop the prediction model. RESULTS: A total of 2939 breasts were eligible, of which 11% underwent an ADM-assisted procedure (single-stage or two-stage). However, 31% underwent a two-stage procedure (with or without the use of ADM). Of all breasts, 10.2% developed a major postoperative complication. Age (OR 1.01), delayed timing (OR 0.71), and two-stage technique (OR 4.46) were associated with the outcome. CONCLUSION: The data suggest that ADM use was not associated with a major postoperative complication, while two-stage reconstructions were strongly associated with an increased risk of major complications. Despite these findings, ADMs are not as popular in the Netherlands as in the USA. The predictive capabilities of the developed model are mediocre to poor, but because of the above findings, we believe that the role of the two-stage technique as a golden standard should be put up for debate. Elsevier 2022-05-12 /pmc/articles/PMC9260237/ /pubmed/35812357 http://dx.doi.org/10.1016/j.jpra.2022.04.007 Text en © 2022 The Authors https://creativecommons.org/licenses/by/4.0/This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Original Article
Hillberg, N.S.
Hogenboom, J.
Hommes, J.
Van Kuijk, S.M.J.
Keuter, X.H.A.
van der Hulst, R.R.W.J.
Risk of major postoperative complications in breast reconstructive surgery with and without an acellular dermal matrix: A development of a prognostic prediction model
title Risk of major postoperative complications in breast reconstructive surgery with and without an acellular dermal matrix: A development of a prognostic prediction model
title_full Risk of major postoperative complications in breast reconstructive surgery with and without an acellular dermal matrix: A development of a prognostic prediction model
title_fullStr Risk of major postoperative complications in breast reconstructive surgery with and without an acellular dermal matrix: A development of a prognostic prediction model
title_full_unstemmed Risk of major postoperative complications in breast reconstructive surgery with and without an acellular dermal matrix: A development of a prognostic prediction model
title_short Risk of major postoperative complications in breast reconstructive surgery with and without an acellular dermal matrix: A development of a prognostic prediction model
title_sort risk of major postoperative complications in breast reconstructive surgery with and without an acellular dermal matrix: a development of a prognostic prediction model
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9260237/
https://www.ncbi.nlm.nih.gov/pubmed/35812357
http://dx.doi.org/10.1016/j.jpra.2022.04.007
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