Few factors are more costly to breast-reconstruction patients — and the overall healthcare infrastructure — than delayed wound healing. With that in mind, a research team from the University of Pennsylvania designed a study to identify risk factors that may be modified and to create a model to assess patient risk of these complications.
The researchers undertook a retrospective study of all free autologous reconstructions at a single institution from 2005 to 2011. They compared patients with delayed wound healing — defined as wounds requiring dressing changes for longer than 3 weeks — to patients with normal healing. A risk model was developed to stratify patients based on the multivariate logistic regression results.
The team found that delayed wound healing affected 297 of 682 patients (44%). These patients were older; had higher body mass index (BMI); and higher rates of medical comorbidities, active smoking and bilateral reconstruction. They also received a lower rate of fluid resuscitation intraoperatively and more commonly received vasopressors, with a greater total reconstructive cost. A regression demonstrated that progressive obesity, smoking, bilateral reconstruction and utilization of vasopressors were associated with delayed healing.
The final model, with three risk groups (low, intermediate and high), demonstrated that high-risk patients have an 86% risk of wound-healing complications, as compared with a 33% risk in patients with few risk factors.
“While patient disease remains a major predictor of wound complications, potentially modifiable variables, including smoking and vasopressor administration, impacted this complication,” the authors write. “Utilizing the simple model to preoperatively assess patient risk, targeted measures can be undertaken with the goal of ultimately reducing wound-healing complications and cost.”
The study was published in the April issue of the Journal of Plastic, Reconstructive and Aesthetic Surgery (JAPRAS).