Ryo Karakawa1, Takaaki Konishi2,3, Hidehiko Yoshimatsu4, Yuma Fuse4, Yohei Hashimoto3, Hiroki Matsui3, Kiyohide Fushimi5, Tomoyuki Yano4, Hideo Yasunaga3. 1. Department of Plastic and Reconstructive Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, Japan. ryo.kyara@gmail.com. 2. Department of Breast and Endocrine Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan. 3. Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan. 4. Department of Plastic and Reconstructive Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, Japan. 5. Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School, Tokyo, Japan.
Abstract
BACKGROUND: Despite the increasing popularity of autologous breast reconstruction, limited evidence is available. The aim of the present study was to compare the short-term outcomes of pedicled- and free-flap breast reconstructions. METHODS: Using a nationwide Japanese inpatient database, we identified 13,838 patients who underwent breast reconstruction for breast cancer (July 2010-March 2020) using a pedicled or free-flap (pedicled- and free-flap groups, n = 8279 and 5559, respectively). One-to-one propensity score matching was performed to compare the occurrence of postoperative complications, duration of anesthesia, length of stay, and total costs between the two groups. We also performed subgroup analyses stratified by hospital volume. RESULTS: The propensity score-matched analysis involving 3524 pairs showed that the pedicled-flap group had significantly lower proportions of takeback (2.1% vs. 3.2%, p < 0.001), thrombosis (0.6% vs. 1.7%, p < 0.001), and postoperative bleeding (2.1% vs. 5.7%, p < 0.001) than the free-flap group. No significant differences were found in wound dehiscence or tissue necrosis. Compared to the free-flap group, the pedicled-flap group had a short duration of anesthesia (412 vs. 647 min, p < 0.001) and low total hospitalization costs (12 662 vs. 17 247 US dollars, p < 0.001) but a prolonged postoperative length of stay (13 vs. 12 days, p < 0.001). The subgroup analyses showed results compatible with those of the main analysis. CONCLUSIONS: In this large nationwide cohort of patients who underwent breast reconstruction, pedicled-flap reconstruction was associated with fewer postoperative complications (excluding necrosis and wound dehiscence) and lower hospitalization costs but a longer postoperative length of stay than free-flap reconstruction.
BACKGROUND: Despite the increasing popularity of autologous breast reconstruction, limited evidence is available. The aim of the present study was to compare the short-term outcomes of pedicled- and free-flap breast reconstructions. METHODS: Using a nationwide Japanese inpatient database, we identified 13,838 patients who underwent breast reconstruction for breast cancer (July 2010-March 2020) using a pedicled or free-flap (pedicled- and free-flap groups, n = 8279 and 5559, respectively). One-to-one propensity score matching was performed to compare the occurrence of postoperative complications, duration of anesthesia, length of stay, and total costs between the two groups. We also performed subgroup analyses stratified by hospital volume. RESULTS: The propensity score-matched analysis involving 3524 pairs showed that the pedicled-flap group had significantly lower proportions of takeback (2.1% vs. 3.2%, p < 0.001), thrombosis (0.6% vs. 1.7%, p < 0.001), and postoperative bleeding (2.1% vs. 5.7%, p < 0.001) than the free-flap group. No significant differences were found in wound dehiscence or tissue necrosis. Compared to the free-flap group, the pedicled-flap group had a short duration of anesthesia (412 vs. 647 min, p < 0.001) and low total hospitalization costs (12 662 vs. 17 247 US dollars, p < 0.001) but a prolonged postoperative length of stay (13 vs. 12 days, p < 0.001). The subgroup analyses showed results compatible with those of the main analysis. CONCLUSIONS: In this large nationwide cohort of patients who underwent breast reconstruction, pedicled-flap reconstruction was associated with fewer postoperative complications (excluding necrosis and wound dehiscence) and lower hospitalization costs but a longer postoperative length of stay than free-flap reconstruction.
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