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Outcomes Analysis of Microsurgical Physiologic Lymphatic Procedures from the National Surgical Quality Improvement Program (NSQIP)
Ravinder Bamba, MD1, Amanda Chu, MD1, Jose Gallegos, BA2, Fernando A. Herrera, MD2*, Aladdin H. Hassanein, MD, MMSc1*
1Division of Plastic Surgery
Indiana University School of Medicine
Indianapolis, IN
2Division of Plastic Surgery
Medical University of South Carolina
Charleston, SC
Indiana University
2021-01-28
Presenter: Ravi Bamba
Affidavit:
I certify that the material proposed for presentation in this abstract has not been published in any scientific journal or previously presented at a major meeting. The program director is responsible for making a statement within the confines of the box below specific to how much of the work on this project represents the original work of the resident. All authors/submitters of each abstract should discuss this with their respective program director for accurate submission of information as well as the program director's approval for inclusion of his/her electronic signature.
Director Name: William Wooden
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: Breast (Aesthetic and Recon.)
Introduction
Physiologic microsurgical procedures to treat lymphedema include vascularized lymph node transfer (VLNT) and lymphovenous bypass (LVB). There is no consensus on timing of treatment, preferred operation, or order in which interventions should be performed. Comparing morbidity of VLNT and LVB may guide use as the initial operation of choice. The purpose of this study was to assess 30-day outcomes of VLNT and LVB using the National Surgical Quality Improvement Program (NSQIP) database.
Methods
NSQIP was queried (2012-2018) for patients treated for postmastectomy lymphedema. Outcomes were assessed for 3 groups: (1) LVB, (2) VLNT, and (3) patients who had procedures simultaneously (VLNA+LVB).
Results
The study included 199 patients who had LVB (n=43), VLNT (n=145), or VLNT+LVB (n=11). Thirty-day complication rates including unplanned reoperation (6.9% VLNT versus 2.3% LVB) and readmission (0.69% VLNT versus none in LVB) were not statistically significant (p=0.54). Surgical site infection, wound complications, deep vein thromboembolism, and cardiac arrest was also similar among the three groups. Postoperative length of stay for VLNT (2.5 days), LVB (1.9 days), and VLNT+LVB (2.8 days) did not differ significantly (p=0.20). Operative time for LVB (305.4 min), VLNT (254 min) and VLNT+LVB (295.3 min) was not significantly different (p=0.21)
Conclusions
Our analysis of the NSQIP data revealed that VLNT and LVB are safe procedures with no significant difference in 30-day perioperative morbidity. However, our results support that choice of VLNT versus LVB can be justifiably made per the surgeon's preference and experience as the operations have similar complication rates.
