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Challenging the BRA Score as an Accurate Predictor of Individualized Risk of Surgical Complications in Breast Reconstruction in an Appalachian Population
Luke Grome, Cody Mullens, Aaron Mason, Cristiane Ueno
West Virginia University School of Medicine
2017-02-01
Presenter: Luke Grome
Affidavit:
This project was designed and performed by the presenter.
Director Name: Cristiane Ueno
Author Category: Medical Student
Presentation Category: Clinical
Abstract Category: Breast (Aesthetic and Recon.)
Introduction:
The Breast Reconstruction Risk assessment score was developed as an accessible online tool for generation of an individual's complication risk following breast reconstruction. This calculator is built on data from the NSQIP and TOPS databases. Minorities within the population may not be accurately represented. The Appalachian population is one group that consistently lacks access to care and has higher rates of comorbidities. The purpose of this study was to challenge the risk assessment generated by BRA when applied to the Appalachian population.
Methods:
A retrospective review of all implant-based breast reconstruction performed at West Virginia University Hospital between December 2014 and 2016 was conducted. Patients who underwent unilateral or bilateral mastectomy were included.
Results:
Ninety-four cases of breast reconstruction met inclusion criteria and were reviewed. Twenty cases resulted in surgical complications. Statistical analysis utilizing the Hosmer-Lemeshow test was used to evaluate the agreement between the observed data and predictions generated by the BRA model. The data suggests that the rate of complications during the observed period was higher than that predicted by the BRA model however the data failed to reach statistical significance.
Discussion:
Based on our findings the BRA score is a valid tool for individualized risk assessment for complications of implant based breast reconstruction when applied to the Appalachian patient population. Although not reaching statistical significance, we observed a decreased complication rate from 2014 to 2016 which can be associated with the positive impact of consistent surgical teams and higher case volumes.
