The use of indocyanine green angiography in postmastectomy reconstruction: Do outcomes improve over time?

Gustave K. Diep, Schelomo Marmor, Scott Kizy, Jing Li Huang, Eric H. Jensen, Pamela Portschy, Bruce Cunningham, Umar Choudry, Todd M. Tuttle, Jane Yuet Ching Hui

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Background: Indocyanine green angiography (ICGA) reduces ischemic complications by assessing mastectomy flap perfusion intraoperatively. However, outcomes of ICGA can be surgeon-dependent due to its relative novelty. We aimed to determine whether patient outcomes improved with the adoption of ICGA over time. Methods: We conducted a single-institution retrospective study of mastectomy patients between March 2012 (date of ICGA introduction) and October 2016. We included patients who underwent immediate expander-based reconstruction with intraoperative ICGA, followed by second-stage permanent implant placement. Patients were chronologically sorted into 3 groups, of 45 patients each, based on the date of ICGA. Complications and reconstruction wait times (time between initial expander placement and subsequent final reconstruction) amongst the 3 groups were evaluated. Using the Cochran–Armitage test for trend, we tested the change in median adjusted expander fill volumes (expander fill volume in milliliter per gram of breast removed) over time. Results: We identified 135 patients. Rates of ischemic complications significantly decreased (Group 1, 36%; Group 2, 22%; Group 3, 11%; p = 0.03), despite significantly increasing median adjusted expander fill volumes (Group 1, 0.46 mL/g; Group 2, 0.63 mL/g; Group 3, 0.76 mL/g; p = 0.003) over time. The rates of unexpected returns to the operating room across the 3 groups were not significantly different. The median reconstruction wait time was significantly reduced in the later groups (Group 1, 146 days; Group 2, 122 days; Group 3, 87 days; p = 0.01). Conclusions: Outcomes for mastectomy with immediate expander-based reconstruction were found to improve with increasing case volume after implementation of ICGA.

Original languageEnglish (US)
Pages (from-to)548-554
Number of pages7
JournalJournal of Plastic, Reconstructive and Aesthetic Surgery
Volume72
Issue number4
DOIs
StatePublished - Apr 2019

Fingerprint

Indocyanine Green
Angiography
Mastectomy
Operating Rooms
Breast
Retrospective Studies
Perfusion

Keywords

  • Breast reconstruction
  • Indocyanine green angiography
  • Mastectomy

PubMed: MeSH publication types

  • Journal Article

Cite this

@article{77ab552896654ddeb9ab74d504e286a2,
title = "The use of indocyanine green angiography in postmastectomy reconstruction: Do outcomes improve over time?",
abstract = "Background: Indocyanine green angiography (ICGA) reduces ischemic complications by assessing mastectomy flap perfusion intraoperatively. However, outcomes of ICGA can be surgeon-dependent due to its relative novelty. We aimed to determine whether patient outcomes improved with the adoption of ICGA over time. Methods: We conducted a single-institution retrospective study of mastectomy patients between March 2012 (date of ICGA introduction) and October 2016. We included patients who underwent immediate expander-based reconstruction with intraoperative ICGA, followed by second-stage permanent implant placement. Patients were chronologically sorted into 3 groups, of 45 patients each, based on the date of ICGA. Complications and reconstruction wait times (time between initial expander placement and subsequent final reconstruction) amongst the 3 groups were evaluated. Using the Cochran–Armitage test for trend, we tested the change in median adjusted expander fill volumes (expander fill volume in milliliter per gram of breast removed) over time. Results: We identified 135 patients. Rates of ischemic complications significantly decreased (Group 1, 36{\%}; Group 2, 22{\%}; Group 3, 11{\%}; p = 0.03), despite significantly increasing median adjusted expander fill volumes (Group 1, 0.46 mL/g; Group 2, 0.63 mL/g; Group 3, 0.76 mL/g; p = 0.003) over time. The rates of unexpected returns to the operating room across the 3 groups were not significantly different. The median reconstruction wait time was significantly reduced in the later groups (Group 1, 146 days; Group 2, 122 days; Group 3, 87 days; p = 0.01). Conclusions: Outcomes for mastectomy with immediate expander-based reconstruction were found to improve with increasing case volume after implementation of ICGA.",
keywords = "Breast reconstruction, Indocyanine green angiography, Mastectomy",
author = "Diep, {Gustave K.} and Schelomo Marmor and Scott Kizy and Huang, {Jing Li} and Jensen, {Eric H.} and Pamela Portschy and Bruce Cunningham and Umar Choudry and Tuttle, {Todd M.} and Hui, {Jane Yuet Ching}",
year = "2019",
month = "4",
doi = "10.1016/j.bjps.2018.12.037",
language = "English (US)",
volume = "72",
pages = "548--554",
journal = "Journal of Plastic, Reconstructive and Aesthetic Surgery",
issn = "1748-6815",
publisher = "Churchill Livingstone",
number = "4",

}

TY - JOUR

T1 - The use of indocyanine green angiography in postmastectomy reconstruction

T2 - Do outcomes improve over time?

AU - Diep, Gustave K.

AU - Marmor, Schelomo

AU - Kizy, Scott

AU - Huang, Jing Li

AU - Jensen, Eric H.

AU - Portschy, Pamela

AU - Cunningham, Bruce

AU - Choudry, Umar

AU - Tuttle, Todd M.

AU - Hui, Jane Yuet Ching

PY - 2019/4

Y1 - 2019/4

N2 - Background: Indocyanine green angiography (ICGA) reduces ischemic complications by assessing mastectomy flap perfusion intraoperatively. However, outcomes of ICGA can be surgeon-dependent due to its relative novelty. We aimed to determine whether patient outcomes improved with the adoption of ICGA over time. Methods: We conducted a single-institution retrospective study of mastectomy patients between March 2012 (date of ICGA introduction) and October 2016. We included patients who underwent immediate expander-based reconstruction with intraoperative ICGA, followed by second-stage permanent implant placement. Patients were chronologically sorted into 3 groups, of 45 patients each, based on the date of ICGA. Complications and reconstruction wait times (time between initial expander placement and subsequent final reconstruction) amongst the 3 groups were evaluated. Using the Cochran–Armitage test for trend, we tested the change in median adjusted expander fill volumes (expander fill volume in milliliter per gram of breast removed) over time. Results: We identified 135 patients. Rates of ischemic complications significantly decreased (Group 1, 36%; Group 2, 22%; Group 3, 11%; p = 0.03), despite significantly increasing median adjusted expander fill volumes (Group 1, 0.46 mL/g; Group 2, 0.63 mL/g; Group 3, 0.76 mL/g; p = 0.003) over time. The rates of unexpected returns to the operating room across the 3 groups were not significantly different. The median reconstruction wait time was significantly reduced in the later groups (Group 1, 146 days; Group 2, 122 days; Group 3, 87 days; p = 0.01). Conclusions: Outcomes for mastectomy with immediate expander-based reconstruction were found to improve with increasing case volume after implementation of ICGA.

AB - Background: Indocyanine green angiography (ICGA) reduces ischemic complications by assessing mastectomy flap perfusion intraoperatively. However, outcomes of ICGA can be surgeon-dependent due to its relative novelty. We aimed to determine whether patient outcomes improved with the adoption of ICGA over time. Methods: We conducted a single-institution retrospective study of mastectomy patients between March 2012 (date of ICGA introduction) and October 2016. We included patients who underwent immediate expander-based reconstruction with intraoperative ICGA, followed by second-stage permanent implant placement. Patients were chronologically sorted into 3 groups, of 45 patients each, based on the date of ICGA. Complications and reconstruction wait times (time between initial expander placement and subsequent final reconstruction) amongst the 3 groups were evaluated. Using the Cochran–Armitage test for trend, we tested the change in median adjusted expander fill volumes (expander fill volume in milliliter per gram of breast removed) over time. Results: We identified 135 patients. Rates of ischemic complications significantly decreased (Group 1, 36%; Group 2, 22%; Group 3, 11%; p = 0.03), despite significantly increasing median adjusted expander fill volumes (Group 1, 0.46 mL/g; Group 2, 0.63 mL/g; Group 3, 0.76 mL/g; p = 0.003) over time. The rates of unexpected returns to the operating room across the 3 groups were not significantly different. The median reconstruction wait time was significantly reduced in the later groups (Group 1, 146 days; Group 2, 122 days; Group 3, 87 days; p = 0.01). Conclusions: Outcomes for mastectomy with immediate expander-based reconstruction were found to improve with increasing case volume after implementation of ICGA.

KW - Breast reconstruction

KW - Indocyanine green angiography

KW - Mastectomy

UR - http://www.scopus.com/inward/record.url?scp=85059745755&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85059745755&partnerID=8YFLogxK

U2 - 10.1016/j.bjps.2018.12.037

DO - 10.1016/j.bjps.2018.12.037

M3 - Article

C2 - 30642794

AN - SCOPUS:85059745755

VL - 72

SP - 548

EP - 554

JO - Journal of Plastic, Reconstructive and Aesthetic Surgery

JF - Journal of Plastic, Reconstructive and Aesthetic Surgery

SN - 1748-6815

IS - 4

ER -