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Comparison of Perioperative Outcomes of Autologous Breast Reconstruction Surgeries
Hossein Masoomi, MD1, Garrett A. Wirth, MD, FACS2, Keyianoosh Paydar, MD, FACS2, Al Aly, MD, FACS2, Gregory RD Evans, MD, FACS2.
1Department of Surgery at University of California, Irvine, Orange, CA, USA, 2Aesthetic & Plastic Surgery Institute, University of California, Irvine, Orange, CA, USA.

PURPOSE: There is no available study comparing perioperative outcomes in all types of autologus breast reconstructive surgery. We evaluated perioperative outcomes of autologous breast reconstruction surgeries including latissimus dorsi myocutaneous flap (LDF), pedicle transverse rectus abdominis myocutaneous (P-TRAM) flap, free transverse rectus abdominis myocutaneous (F-TRAM) flap, free deep inferior epigastric artery perforator (DIEP) flap, free superficial inferior epigastric artery (SIEA) flap and free gluteal artery perforator (GAP) flap.
METHODS: In this study, we used the Nationwide Inpatient Sample (NIS) database which is the largest inpatient care database available in the United States. We examined the clinical data of patients who underwent autologous breast reconstructive surgery from 2009 to 2010 (the latest available years from this database). Outcome measures included postoperative complications, length of hospital stay and total hospital charges.
RESULTS: A total of 35,883 patients underwent autologous breast reconstructive surgery during these two years. The most common breast reconstruction type was LDF (29.4%) followed by DIEP (22.7%), P-TRAM (20.2%), F-TRAM (18.3%), SIEP (0.9%), GAP (0.6%) and 7.9% of patients was coded in the not-otherwise specified group. The lowest complication rate observed in LDF group (6.2%) followed by P-TRAM group (6.8%), DIEP group (7.5%), F-TRAM group (7.9%), SIEP group (13.2%) and GAP group (13.2%). The shortest mean length of hospital stay was 2.9 days in LDF group followed by 4.3 days in P-TRAM group, 4.6 days in DIEP group, 4.6 days in SIEA group, 4.7 days in F-TRAM group and 5.2 days in GAP group respectively. Also, the lowest mean total hospital charges was in LDP group ($44,873) followed by P-TRAM group ($52,082), F-TRAM group ($73,976), DIEP group ($84,191), SIEA group ($90,084) and GAP group ($91,946).
CONCLUSION: LDF is the most commonly performed autologous breast reconstruction surgery in 2009-2010 in the United States. LDF was associated with the lowest complication rate, shortest hospital stay and lowest total hospital charges among the autologous breast reconstructive surgeries. Also, GAP was associated with the worst evaluated
perioperative outcomes among the autologous breast reconstruction surgeries. Further prospective randomized studies should be conducted to analyze the long term superiority of LDF in autologous breast reconstructive surgery.


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