RESUMEN
BACKGROUND: We aimed to assess whether the use of the harmonic scalpel (HS) in axillary dissection would reduce long-term shoulder-arm morbidity compared to traditional instruments (TIs). MATERIALS AND METHODS: A retrospective analysis on 180 patients who underwent standard axillary dissection for breast cancer between 2007 and 2015 was carried out. All patients were evaluated for postoperative pain, impairment of shoulder-arm mobility, seroma formation in axilla, frozen shoulder, and lymphedema. RESULTS: HS procedure on average was 50% shorter compared to the TI technique. HS reduced by 4.5 times the risk of axillary seroma. TIs were associated with 4 times higher risk of developing a painful frozen shoulder. CONCLUSIONS: Use of the HS was associated with reduced costs and a positive long-term effect on shoulder-arm morbidity. Axillary seromas are not the only reason of later postoperative shoulder-arm morbidity: other mechanisms are hypothesized in the onset of this very disabling disorder.
Asunto(s)
Linfedema del Cáncer de Mama/epidemiología , Neoplasias de la Mama/cirugía , Bursitis/epidemiología , Dolor Postoperatorio/epidemiología , Biopsia del Ganglio Linfático Centinela/efectos adversos , Seroma/epidemiología , Procedimientos Quirúrgicos Ultrasónicos/efectos adversos , Adulto , Anciano , Anciano de 80 o más Años , Brazo/fisiopatología , Axila , Linfedema del Cáncer de Mama/economía , Linfedema del Cáncer de Mama/fisiopatología , Neoplasias de la Mama/patología , Bursitis/economía , Bursitis/fisiopatología , Ahorro de Costo , Femenino , Estudios de Seguimiento , Humanos , Metástasis Linfática/diagnóstico , Metástasis Linfática/patología , Mastectomía/efectos adversos , Mastectomía/instrumentación , Persona de Mediana Edad , Dolor Postoperatorio/economía , Dolor Postoperatorio/fisiopatología , Rango del Movimiento Articular/fisiología , Estudios Retrospectivos , Biopsia del Ganglio Linfático Centinela/instrumentación , Seroma/economía , Seroma/fisiopatología , Hombro/fisiopatología , Factores de Tiempo , Resultado del Tratamiento , Procedimientos Quirúrgicos Ultrasónicos/instrumentaciónRESUMEN
BACKGROUND: The objectives of this study were to compare, by patient obesity status, the contemporary utilization patterns of different reconstruction surgery types, understand postoperative complication profiles in the community setting, and analyze the financial impact on health care payers and patients. METHODS: Using data from the MarketScan Health Risk Assessment Database and Commercial Claims and Encounters Database, we identified breast cancer patients who received breast reconstruction surgery following mastectomy between 2009 and 2012. The Cochran-Armitage test was used to evaluate the utilization pattern of breast reconstruction surgery. Multivariable logistic regressions were used to estimate the association between obesity status and infectious, wound, and perfusion complications within one year of surgery. A generalized linear model was used to compare total, complication-related, and out-of-pocket costs. RESULTS: The rate of TE/implant-based reconstruction increased significantly for non-obese patients but not for obese patients during the years analyzed, whereas autologous reconstruction decreased for both patient groups. Obesity was associated with higher odds of infectious, wound, and perfusion complications after TE/implant-based reconstruction, and higher odds of perfusion complications after autologous reconstruction. The adjusted total healthcare costs and out-of-pocket costs were similar for obese and non-obese patients for either type of breast reconstruction surgery. CONCLUSIONS: A greater likelihood of one-year complications arose from TE/implant-based vs autologous reconstruction surgery in obese patients. Given that out-of-pocket costs were independent of the type of reconstruction, greater emphasis should be placed on conveying the surgery-related complications to obese patients to aid in patient-based decision making with their plastic surgeons and oncologists.