| Objective: Based on the follow-up visit to the patients with breast cancer who received one-step(direct-to-implant)breast reconstruction surgery and two-step(tissue expander/implant reconstruction)breast reconstruction surgery after mastectomy,the paper aims to compare the postoperative complications and satisfaction of the two surgeries,and evaluate their health economics,so as to provide reference for clinicians to optimize the surgical scheme for patientsMethods: 1.Study population: the breast cancer patients who underwent immediate implant breast reconstruction surgery in the Breast Disease Center of the Affiliated Hospital of Qingdao University from September 2018 to December 2020 were screened and visited.The inclusion criteria included the patients with primary breast cancer confirmed by histopathology,without distant metastasis,and received immediate breast reconstruction with a prosthesis or expander.Exclusion criteria included the patients with severe breast ptosis,the patients receiving neoadjuvant therapy,and patients with severe complications or immune system diseases.2.Data collection: the patients were divided into one-step group and two-step group according to the operational method.The clinicopathological information and operation related information were collected.Clavien-Dindo grading system was used to evaluate the incidence of postoperative complications and the incidence and the influencing factors were compared between the two groups.The satisfaction of the two groups after breast reconstruction was compared by filling in the BREAST-Q questionnaire before and after operation.The health economics of the two surgical methods was evaluated through cost-effectiveness analysis method.3.Analysis methods: Mann-Whitney test or t-test was used for comparison between measurement data groups,and ? 2 test or Fisher exact test was used for comparison between enumeration data groups.The factors with P<0.2 in univariate analysis were included in Logistic regression multivariate analysis,P<0.05 had statistical significance.Results: A total of 244 eligible breast cancer patients were included in this study,including 124 in one-step group and 120 in two-step group.The median follow-up time was 18 months(3-32 months).1.Postoperative complications and influencing factors: the incidence of surgery-related complications was 29.0% in the one-step group and 22.5% in the two-step group.The total incidence of complications was similar between the two groups(?2=1.359,P=0.244).The incidence of poor wound healing in one-step group was significantly higher than that in two-step group(15.3% vs.3.3%,?2=10.267,P=0.001).79.4% of the patients’ complications were Clavien-Dindo Grade I-IIIa,which only required Outpatient treatment.Multivariate analysis showed that patients with breast mesh(OR=2.501,95%CI 1.331-4.697)and without prophylactic antibiotics(OR=0.180,95%CI 0.093-0.346)were independent influencing factors of postoperative complications.Smoking history(OR=5.673,95% CI 1.138-28.270)and two-step surgery(OR=0.188,95%CI 0.062-0.576)were independent influencing factors of poor wound healing.2.Patient satisfaction and influencing factors: according to patients’ postoperative BREAST-Q scales results,the breast satisfaction and the degree of social and psychological health in the two-step group were significantly higher than those in the one-step group(P<0.05).And the decrease of postoperative score in two-step group was less than that in one-step group(P<0.001).Multivariate analysis showed that patients with two-step surgery(OR=0.489,95%CI 0.276-0.866)and nipple areola preservation(OR=0.383,95%CI 0.177-0.827)had higher breast satisfaction.The two-step surgery(OR=0.449,95%CI 0.251-0.804)and the postoperative complications(OR=1.976,95%CI1.046-3.730)were independent influencing factors of the patients’ psychosocial health.3.Health economics evaluation: the hospitalization days,total hospitalization expenses,operation expenses,dressing change times,dressing change expenses and days when life was affected of patients in the two-step group were more than those in the one-step group(P<0.001).The cost-effectiveness ratio of one-step surgery was lower than that of two-step surgery(36814.70 vs 43460.00),meaning patients undergoing one-step surgery would bear less medical treatment burden than those undergoing two-step surgery to achieve the same surgery effect.Conclusion: Breast reconstruction with implants is feasible in early breast cancer patients.The overall incidence of postoperative complications of patients undergoing one-step surgery is similar to that of patients undergoing two-step surgery,but the incidence of the poor wound healing of the patients undergoing two-step surgery is significantly lower than that of the patients undergoing one-step surgery.The patients undergoing two-step surgery have higher degree of breast satisfaction and better social and psychological health.Cost-effectiveness analysis shows that one-step surgery has greater the economic benefit.It is advisable for clinicians to choose the appropriate operation method according to the clinicopathological characteristics,patients’ willingness and economic level. |
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