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Researchers create new breast reconstruction risk assessment tool using TOPS database

Researchers created a more individualized risk analysis assessment for patients undergoing breast reconstruction to more accurately assess risk factors in an individual patient rather than relying on data from population-based metrics.

Using the Tracking Operations and Outcomes for Plastic Surgeons (TOPS) database, they identified patients undergoing immediate breast reconstruction. Of the total patients, 4,439 met inclusion criteria with no missing perioperative data.

For this study, researchers were interested in the variables of seroma, dehiscence, surgical site infection, partial or full flap loss, explantation and reoperation. Overall incidence was 3.4% for seroma, 4% for SSI, 6.1% for dehiscence, 3.7% for explantation, 7% for flap loss and 6.4% for reoperation.

Researchers noted that clinical characteristics were different between patients who experienced a complication and those who did not.

They developed risk models to calculate a predicted probability for each respective complication.

The models use five covariates in addition to reconstructive modality to determine a patient’s probability of a given outcome: age, BMI, smoking status, diabetes and ASA class of greater than 2.

Researchers used the models to create the interactive risk calculator, www.BRAScore.org.

The online calculator allows patient and surgeon to input factors to ascertain the estimated risk of seroma, surgical site infection, dehiscence, flap failure, explantation and reoperation.

With current risk probabilities, most patients have their risk overestimated, whereas patients with the highest risk have their risk underestimated. – by Abigail Sutton

Disclosure: Kim receives research funding from the Musculoskeletal Transplant Foundation. Please see the full study for a full list of all other authors’ relevant financial disclosures.