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Evaluation of the BRA-Score for Breast reconstruction pre-operative risk assessment
Eliana F.R. Duraes, MD,PhD; Morgan Fish, BA; Leonardo Duraes, MD, PhD; Stephanie Kortyka, MD; Joseph Abraham, BA; Joao B Sousa, MD, PhD; Steven Bernard, MD; Andrea Moreira, MD; Graham S. Schwarz, MD; Risal S. Djohan, MD
Cleveland Clinic
2017-02-15
Presenter: Eliana F.R. Duraes
Affidavit:
Eliana Duraes
Director Name: Steven L Bernard
Author Category: Fellow Plastic Surgery
Presentation Category: Clinical
Abstract Category: Breast (Aesthetic and Recon.)
Purpose – The BRA-Score has been proposed to calculate the pre-operative risk of breast reconstruction patients. Our aim was to validate the BRA-Score as a risk calculator for its practical use.
Methods – Patients after different types of breast reconstruction had their pre-operative risk retrospectively calculated using the BRA Score, which was compared to the complications developed. Using the BRA Score we calculated risk of overall complication based on MROC (Risk-MROC) and TOPS (Risk-TOPS), surgical site infection risk (SSI-Risk), and 30 day reoperation risk (Reop-Risk). Data gathered included post-operative overall complications (PO-Comp), surgical site infection (SSI), and reoperations due to complications. Group 1 included breasts that developed the predicted complication; group 2, breasts without the complication. The ROC curve was used to evaluate the calculator as a predictor test.
Results – Charts from 255 patients (389 reconstructed breasts) were evaluated. Compared to Group 2, Group 1 had a higher Risk-MROC (20.8±11.12 vs 15.24±9.16, p≤0.01), Risk-TOPS (19.7±7.28 vs 15.5±6.56, p≤0.01), and Reop-Risk (7.48±3.27 vs 6.22±5.22, p≤0.01); and similar SSI-Risk (3.75±2.3 vs 3.94±2.38, p=0.96). As tests for predicting the PO-Comp, Risk-MROC and Risk-TOPS were adequate, with areas under the ROC curve of 0.662 and 0.669, respectively. For predicting reoperations, Risk-MROC, Risk-TOPS, and Reop-Risk presented areas of 0.666, 0.691, and 0.652, respectively.
Conclusions – The BRA Score was a helpful tool to predict overall complications and reoperations. The calculator was not useful in predicting surgical site infection. By using BRA Score, we can reliably identify patients at a higher risk for post-operative complications which can facilitate counseling.
