Lack of Validity of the ACS-NSQIP Database for Alloplastic Post-Mastectomy Reconstruction
John Compoginis, MD, Edward Luce, MD, Charles Pierce, MD.
University of Tennessee Health Sciences, Memphis, TN, USA.
The ACS-NSQIP is an outcomes-based program with the objective to improve quality of surgical care. Attracted by size and validity, the ACS-NSQIP database has been mined by both general and plastic surgery clinical researchers to provide information for possible risk reduction strategies and patient counseling. Yet, the 30-day window of the ACS-NSQIP database may be inappropriately brief in documentation of complications for some operative procedures. For example, the database was recently examined for the incidence of readmission following immediate post-mastectomy reconstruction1.
The hypothesis was the ACS-NSQIP database under-estimated complications in alloplastic reconstruction, in particular, prosthesis loss. A cohort2 of immediate post-mastectomy reconstruction with tissue expanders was reviewed for the hiatus between implantation and prosthesis loss (explantation).
Of 511 breasts reconstructed with immediate placement of tissue expanders, 55 were explanted due to infection and/or exposure. Of the total, 19 were explanted in 30 days or less, 36 afterward, a mean of 62.1 and median of 43 days (Figure1).
The ACS-NSQIP database, originally developed for application to general and vascular surgery, may not be appropriate for analysis of post-mastectomy alloplastic breast reconstruction complications.
1. Nelson JA, Fischer JP, PRS, (2014); 134:193e-201e.
2. Parks JW, et al., PRS, (2012); 130:739-746.
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