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J Reconstr Microsurg 2023; 39(08): 664-670
DOI: 10.1055/a-2056-0909
Original Article

A Comparison of Postoperative Outcomes Between Immediate, Delayed Immediate, and Delayed Autologous Free Flap Breast Reconstruction: Analysis of 2010–2020 NSQIP Data

Jessica L. Marquez 
1   Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah
,
Jack D. Sudduth
1   Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah
,
Keith Kuo
1   Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah
,
Ashraf A. Patel
1   Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah
,
Devin Eddington
2   Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah
,
Jayant P. Agarwal
1   Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah
,
Alvin C. Kwok
1   Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah
› Author Affiliations Funding None.
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Abstract

Background While many factors influence decisions related to the timing between mastectomy and flap-based breast reconstruction, there is limited literature comparing postoperative complications between immediate (IBR), delayed immediate (DIBR), and delayed (DBR) reconstruction modalities. Using the National Surgical Quality Improvement Program (NSQIP), we sought to compare postoperative complication rates of each timing modality.

Methods The NSQIP 2010–2020 database was queried for patients who underwent free flap breast reconstruction. Cases were categorized to include mastectomy performed concurrently with a free flap reconstruction, removal of a tissue expander with free flap reconstruction, and free flap reconstruction alone which are defined as IBR, DIBR, and DBR, respectively. The frequency of postoperative outcomes including surgical site infection (SSI), wound dehiscence, intraoperative transfusion, deep venous thrombosis (DVT), and return to operating room (OR) was assessed. Overall complication rates, hospital length of stay (LOS), and operative time were analyzed. Multivariable regression analysis controlling for age, race, BMI, diabetes, hypertension, ASA class, and laterality was performed.

Results A total of 7,907 cases that underwent IBR, DIBR (n = 976), and DBR reconstruction (n = 6,713) were identified. No statistical difference in occurrence of SSIs, wound dehiscence, or DVT was identified. DIBR (9%) and DBR (11.9%) were associated with less occurrences of reoperation than IBR (13.2%, p < 0.001). Univariate and multivariate regression analysis demonstrated that DIBR and DBR were associated with a lower odds of complications and shorter operation time versus IBR. No statistically significant differences between DIBR and DBR in surgical complications, LOS, and operative time were identified.

Conclusion Awareness of overall complication rates associated with each reconstructive timing modality can be used to help guide physicians when discussing reconstructive options. Our data suggests that DIBR and DBR are associated with less overall complications than IBR. Physicians should continue to consider patients' unique circumstances when deciding upon which timing modality is appropriate.

Keywords

breast reconstruction - immediate breast reconstruction - delayed breast reconstruction - delayed immediate breast reconstruction - NSQIP

Authors' Contributions

All the authors appropriately contributed to the development of this manuscript. The conceptualization of the goals/aims of the article was driven by A.C.K., J.P.A., J.L.M., and J.S. The formal acquisition of the data was performed by J.L.M. and J.S. Data analysis was conducted by D.E. J.L.M., J.S., K.K., A.A.P., J.P.A., and A.C.K. were involved in drafting and revising the final version for submission.


Supplementary Material



Publication History

Received: 01 September 2022

Accepted: 21 February 2023

Accepted Manuscript online:
16 March 2023

Article published online:
11 April 2023

© 2023. Thieme. All rights reserved.

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