John Y S Kim1, Nima Khavanin, Sumanas W Jordan, Jon P Ver Halen, Alexei S Mlodinow, Kevin P Bethke, Seema A Khan, Nora M Hansen, Albert Losken, Neil A Fine. 1. Chicago, Ill.; Memphis, Tenn.; and Atlanta, Ga. From the Division of Plastic and Reconstructive Surgery and the Lynn Sage Comprehensive Breast Center, Northwestern University, Feinberg School of Medicine; the Department of Plastic and Reconstructive Surgery, Baptist Cancer Center/Vanderbilt Ingram Cancer Center; and the Division of Plastic and Reconstructive Surgery, Emory University Hospital.
Abstract
BACKGROUND: Risk factors for surgical-site infection following beast reconstruction have been thoroughly investigated at a population level. However, traditional population-based measures may not always capture the nuances of individual patients. The authors aimed to develop a validated breast reconstruction risk assessment calculator for surgical-site infection that informs risk at an individual level. METHODS: Mastectomies with immediate reconstruction (n = 16,069) from 2005 to 2011 were identified from the National Surgical Quality Improvement Program database. A multiple logistic regression model was created for postoperative surgical-site infection. Hosmer-Lemeshow, C statistic, and Brier score were computed to assess model performance. Bootstrap analysis validated the model. RESULTS: A robust, validated risk model for surgical-site infection was developed using 11 covariates. The model Hosmer-Lemeshow p value was 0.371, the Brier score was 0.0357, and the C statistic was 0.682 (optimism-corrected C statistic, 0.678). The distribution of individual risks demonstrated a positive skew. Population-derived risk underestimated or overestimated individual risk by at least 1.5-fold in nearly one-fifth of all patients. CONCLUSIONS: The breast reconstruction risk assessment score risk calculator for surgical-site infection mitigates the potentially inaccurate interpolation of population-based risk to individual patients. The authors concomitantly developed an online interface-accessible by patients and surgeons alike-to quantify a patient's risk for surgical-site infection, better informing evidence-based decisions and managing patient expectations. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.
BACKGROUND: Risk factors for surgical-site infection following beast reconstruction have been thoroughly investigated at a population level. However, traditional population-based measures may not always capture the nuances of individual patients. The authors aimed to develop a validated breast reconstruction risk assessment calculator for surgical-site infection that informs risk at an individual level. METHODS: Mastectomies with immediate reconstruction (n = 16,069) from 2005 to 2011 were identified from the National Surgical Quality Improvement Program database. A multiple logistic regression model was created for postoperative surgical-site infection. Hosmer-Lemeshow, C statistic, and Brier score were computed to assess model performance. Bootstrap analysis validated the model. RESULTS: A robust, validated risk model for surgical-site infection was developed using 11 covariates. The model Hosmer-Lemeshow p value was 0.371, the Brier score was 0.0357, and the C statistic was 0.682 (optimism-corrected C statistic, 0.678). The distribution of individual risks demonstrated a positive skew. Population-derived risk underestimated or overestimated individual risk by at least 1.5-fold in nearly one-fifth of all patients. CONCLUSIONS: The breast reconstruction risk assessment score risk calculator for surgical-site infection mitigates the potentially inaccurate interpolation of population-based risk to individual patients. The authors concomitantly developed an online interface-accessible by patients and surgeons alike-to quantify a patient's risk for surgical-site infection, better informing evidence-based decisions and managing patient expectations. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.
Authors: Lindsey N Urquia; Silas P Henderson; Jordyn T Farewell; Sofia Duque; Maycie Garibay; Julia Nevin; Andrew Y Zhang Journal: Aesthet Surg J Open Forum Date: 2022-05-02
Authors: John Y S Kim; Alexei S Mlodinow; Nima Khavanin; Keith M Hume; Christopher J Simmons; Michael J Weiss; Robert X Murphy; Karol A Gutowski Journal: Plast Reconstr Surg Glob Open Date: 2015-06-05
Authors: Jordan T Blough; Michael M Vu; Cecil S Qiu; Alexei S Mlodinow; Nima Khavanin; Neil A Fine; John Y S Kim Journal: Plast Reconstr Surg Glob Open Date: 2018-12-12
Authors: Margaret A Olsen; Katelin B Nickel; Julie A Margenthaler; Ida K Fox; Kelly E Ball; Daniel Mines; Anna E Wallace; Graham A Colditz; Victoria J Fraser Journal: Ann Surg Oncol Date: 2016-01-28 Impact factor: 5.344