Abstract/Description/Artist Statement
Introduction: Reconstruction using Deep Inferior Epigastric Perforator (DIEP) flaps is standard for muscle-sparing breast restoration following mastectomy. Staging the procedure in two is becoming increasingly common and an option for community surgeons to decrease operation-specific time burden. We hypothesize that in our community hospital-based cohort, staged reconstruction will be associated with lower recovery burden and decreased complication risk.
Methods: This study was a retrospective single-surgeon cohort of patients receiving staged, immediate or unilateral DIEP breast reconstruction (N = 276) from 2011-2021. Procedure-level multivariate regression evaluated surgical time, Length of stay, opioid use (MME), and perioperative change. Patient-level multivariate regression assessed major complications.
Results: Immediate bilateral DIEPs were seen to have 75% more MME used per operation than staged reconstruction. (β=0.558, p< 0.001). PCA use was the strongest predictor, with a 7.6X increase in MMEs (β=2.028, p< 0.001). Immediate reconstruction was seen to take an additional 5 hours and had a 28% longer stay per operation (β=302.05, p< 0.001) (β=0.247, p=0.082). A greater perioperative drop in hemoglobin was seen with immediate cases (−0.757 g/dL, p=0.031). No adjusted difference was seen in total complication rates, but an increased rate of breast procedure site infections was seen in the immediate procedure (OR=12.68, p=0.030).
Conclusion: In this cohort, staged DIEP reconstruction was associated with lower postoperative recovery burden and opioid usage, with decreased breast site infections. These findings support staging as a feasible strategy in community practice.
Faculty Advisor/Mentor
Lawrence Colen
Faculty Advisor/Mentor Email
colenlb@odu.edu
Faculty Advisor/Mentor Department
Eastern Virginia Medical School Plastic and Reconstructive Surgery
College/School Affiliation
Eastern Virginia School of Medicine
Student Level Group
Medical
Presentation Type
Poster
Included in
Staged Versus Immediate Bilateral Deep Inferior Epigastric Perforator Flap Breast Reconstruction In A Community Hospital Setting: A Procedure And Patient‑Level Analysis Of Recovery Burden And Safety:
Introduction: Reconstruction using Deep Inferior Epigastric Perforator (DIEP) flaps is standard for muscle-sparing breast restoration following mastectomy. Staging the procedure in two is becoming increasingly common and an option for community surgeons to decrease operation-specific time burden. We hypothesize that in our community hospital-based cohort, staged reconstruction will be associated with lower recovery burden and decreased complication risk.
Methods: This study was a retrospective single-surgeon cohort of patients receiving staged, immediate or unilateral DIEP breast reconstruction (N = 276) from 2011-2021. Procedure-level multivariate regression evaluated surgical time, Length of stay, opioid use (MME), and perioperative change. Patient-level multivariate regression assessed major complications.
Results: Immediate bilateral DIEPs were seen to have 75% more MME used per operation than staged reconstruction. (β=0.558, p< 0.001). PCA use was the strongest predictor, with a 7.6X increase in MMEs (β=2.028, p< 0.001). Immediate reconstruction was seen to take an additional 5 hours and had a 28% longer stay per operation (β=302.05, p< 0.001) (β=0.247, p=0.082). A greater perioperative drop in hemoglobin was seen with immediate cases (−0.757 g/dL, p=0.031). No adjusted difference was seen in total complication rates, but an increased rate of breast procedure site infections was seen in the immediate procedure (OR=12.68, p=0.030).
Conclusion: In this cohort, staged DIEP reconstruction was associated with lower postoperative recovery burden and opioid usage, with decreased breast site infections. These findings support staging as a feasible strategy in community practice.