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
Abstract
:1. Introduction
2. Materials and Methods
2.1. Patient Cohort
2.2. Statistical Analysis
3. Results
3.1. Descriptive Data
3.2. Perioperative Details
3.3. Postoperative Complications and Comparison of Low- and High-Volume Centers
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Criteria for DGPRÄC Certification |
---|
Centers must perform at least 100 annual breast procedures |
At least 20 microsurgical breast reconstructions must be performed by a single surgeon |
Five of these procedures may be performed as teaching operations |
Procedures performed by an assistant surgeon (aside from teaching operations) are not counted |
Variable | |
---|---|
Patients, n | 3926 |
Free flaps, n | 4577 |
Age, years | |
Mean (SD) | 51.30 (31.61) |
BMI, kg/m2 | |
Mean (SD) | 26.28 (4.44) |
Immediate reconstruction, n (%) | 1136 (24.8) |
Secondary reconstruction, n (%) | 3441 (75.2) |
Reconstructed side, n (%) | |
Right | 1560 (34.1) |
Left | 1676 (36.6) |
Both | 1341 (29.3) |
Smoking history, n (%) | 476 (10.4) |
Comorbidities, n (%) | |
Diabetes mellitus | 125 (2.7) |
Coagulopathy * | 71 (1.6) |
Abdominal scar >10 cm, n (%) | 192 (4.2) |
Family history of breast and/or ovarian cancer in FDRs, n (%) | 1191 (26.0) |
Genetic disposition, n (%) ** | 697 (15.2) |
Chemotherapy within the last 6 months, n (%) *** | 2605 (56.9) |
Chemotherapy prior to the last 6 months, n (%) **** | 2206 (48.2) |
Immunosuppressive therapy, n (%) + | 34 (0.7) |
Tamoxifen therapy, n (%) ++ | 484 (10.6) |
Indication, n (%) | |
Status after mastectomy | 1555 (40.5) |
DCIS | 180 (4.7) |
Primary carcinoma | 436 (11.4) |
Familial risk +++ | 262 (6.8) |
Complications after prior reconstructive procedures ++++ | 813 (21.2) |
Benign tumor | 47 (1.2) |
Status after BCT | 321 (8.4) |
Tumor recurrence | 122 (3.2) |
other | 105 (2.7) |
Variable | |
---|---|
Free flaps, n | 4577 |
Operation time, min | |
Mean (SD) | 318.60 (127.94) |
Ischemia time, min | |
Mean (SD) | 50.81 (25.86) |
Recipient, n (%) | |
Internal mammary | 3683 (80.5) |
Thoracodorsal | 704 (15.4) |
Other | 190 (4.2) |
Perioperative antibiotics, n (%) | 4399 (96.1) |
Postoperative mobilization, n (%) | |
Day 1 | 3293 (72.0) |
Day 2 | 773 (16.9) |
Day 3 | 126 (2.8) |
Day >3 | 378 (8.3) |
LOS, days | |
Mean (SD) | 8.47 (11.42) |
Variable | |
---|---|
Free flaps, n | 4577 |
Total flap loss, n (%) | 92 (2.0) |
Partial flap loss, n (%) | 51 (1.1) |
Emergent vascular revision surgery, n (%) | 197 (4.3) |
Venous thrombosis | 123 (2.7) |
Arterial thrombosis | 74 (1.6) |
Revision due to wound complications, n (%) | 378 (8.3) |
Infection donor site | 23 (0.5) |
Infection recipient site | 20 (0.4) |
Hematoma donor site | 37 (0.8) |
Hematoma recipient site | 148 (3.2) |
Wound-healing disturbances at donor site | 80 (1.7) |
Wound-healing disturbances at recipient site | 70 (1.5) |
Medical complications, n (%) | 294 (6.4) |
Variable | LV Centers | HV Centers | p Value |
---|---|---|---|
Patients, n | 1260 | 2653 | |
Free flaps, n | 1459 | 3118 | |
Operation time (min) | |||
Mean (SD) | 385.82 (142.31) | 287.14 (107.01) | <0.001 |
Ischemia time (min) | |||
Mean (SD) | 51.81 (27.36) | 50.34 (25.12) | 0.073 |
Recipient, n (%) | <0.001 | ||
Internal mammary | 1312 (89.9) | 2371 (76.0) | |
Thoracodorsal | 60 (4.1) | 644 (20.7) | |
Other | 87 (6.0) | 103 (3.3) | |
Postoperative mobilization, n (%) | <0.001 | ||
Day 1 | 472 (32.4) | 2821 (90.6) | |
Day 2 | 488 (33.5) | 285 (9.1) | |
Day 3 | 118 (8.1) | 8 (0.3) | |
Day 4 | 166 (11.4) | 0 (0.0) | |
Day 5 | 98 (6.7) | 0 (0.0) | |
Day 6 | 72 (4.9) | 0 (0.0) | |
Day 7 | 42 (2.9) | 0 (0.0) | |
LOS, days | |||
Mean (SD) | 9.04 (18.87) | 8.21 (5.04) | 0.023 |
Variable | LV Centers | HV Centers | p Value |
---|---|---|---|
Free flaps, n | 1459 | 3118 | |
Total flap loss, n (%) | 18 (1.2) | 74 (2.4) | 0.014 |
Partial flap loss, n (%) | 20 (1.4) | 31 (1.0) | 0.327 |
Emergent vascular revision surgery, n (%) | 58 (4.0) | 139 (4.5) | 0.453 |
Venous thrombosis | 38 (2.6) | 85 (2.7) | 0.889 |
Arterial thrombosis | 20 (1.4) | 54 (1.7) | 0.437 |
Revision due to wound complications, n (%) | 158 (10.8) | 220 (7.1) | <0.001 |
Infection donor site | 9 (0.6) | 14 (0.4) | 0.6 |
Infection recipient site | 6 (0.4) | 14 (0.4) | 1 |
Hematoma donor site | 15 (1.0) | 22 (0.7) | 0.338 |
Hematoma recipient site | 56 (3.8) | 92 (3.0) | 0.136 |
Wound-healing disturbances donor site | 33 (2.3) | 47 (1.5) | 0.09 |
Wound-healing disturbances recipient site | 39 (2.7) | 31 (1.0) | <0.001 |
Medical complications, n (%) | 105 (7.2) | 189 (6.1) | 0.144 |
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Heidekrueger, P.I.; Moellhoff, N.; Horch, R.E.; Lohmeyer, J.A.; Marx, M.; Heitmann, C.; Fansa, H.; Geenen, M.; Gabka, C.J.; Handstein, S.; et al. 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. J. Clin. Med. 2021, 10, 1016. https://doi.org/10.3390/jcm10051016
Heidekrueger PI, Moellhoff N, Horch RE, Lohmeyer JA, Marx M, Heitmann C, Fansa H, Geenen M, Gabka CJ, Handstein S, et al. 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. Journal of Clinical Medicine. 2021; 10(5):1016. https://doi.org/10.3390/jcm10051016
Chicago/Turabian StyleHeidekrueger, Paul I., Nicholas Moellhoff, Raymund E. Horch, Jörn A. Lohmeyer, Mario Marx, Christoph Heitmann, Hisham Fansa, Matthias Geenen, Christian J. Gabka, Steffen Handstein, and et al. 2021. "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" Journal of Clinical Medicine 10, no. 5: 1016. https://doi.org/10.3390/jcm10051016
APA StyleHeidekrueger, P. I., Moellhoff, N., Horch, R. E., Lohmeyer, J. A., Marx, M., Heitmann, C., Fansa, H., Geenen, M., Gabka, C. J., Handstein, S., Prantl, L., & von Fritschen, U. (2021). 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. Journal of Clinical Medicine, 10(5), 1016. https://doi.org/10.3390/jcm10051016