American Association of Plastic Surgeons

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Pre-operative Identification of Patients with High Risk of Breast Reconstruction Surgical Complications in More than 1300 Breast Reconstructions
Eliana FR Duraes, MD, PhD, Isis Scomacao, MD, Morgan Fish, BA, Sagar Rambhia, BA, Humzah Quereshy, BA, Pauline Van Dijck, BA, Leonardo C. Duraes, MD, PhD, Steven L. Bernard, MD, Andrea A. Moreira, MD, Graham Schwarz, MD, FACS, Risal S. Djohan, MD, FACS.
Cleveland Clinic, Cleveland, OH, USA.

PURPOSE: Our aim was to validate the BRA-Score as a pre-operative risk calculator for its practical use.
METHODS: Patients that underwent different types of breast reconstruction had their pre-operative risk retrospectively calculated per breast using the BRA-Score, and the developed complications were collected. The following groups were considered: group 1, reconstructed breasts that developed the predicted complication; group 2, breasts without the complication. The ROC curve was used to evaluate the calculated risk as a complication predictor test.
RESULTS: Charts of 1399 breast reconstructions from 941 patients were evaluated. The surgery used to calculate the BRA-Score was direct to implant in 23 breasts; Free-flaps, 285; Latissimus, 107; Pedicled-TRAM, 71, and Tissue expander in 913. Compared to Group 2, Group 1 had a significantly higher Overall complication risk (Comp-Risk) (21.909.37 vs16.417.45, p≤0.01), reoperation risk (Reop-Risk) (7.984.08 vs 6.163.17, p≤0.01); and surgical site infection risk (SSI-Risk) (7.045.04 vs 4.594.31, p<0.05); and clinical complication risk (Clinical-comp-risk) (10.418.78 vs 4.737.20, p<0.05). As tests for predicting complications, Comp-risk was adequate, with areas under the ROC curve of 0.66. For predicting the reoperations, Reop-Risk presented an area of 0.652. A predicted comp-risk of 25% would provide a specificity of 79% to identify high risk patients.
CONCLUSION: The BRA-Score is a helpful tool to predict complications. An overall complication risk of 25% would provide high specificity in determining a high risk patient. Patients with such high pre-operative risk may benefit from modifications in the breast reconstruction treatment plan to lower the complication rate.


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