Reconstrucción mamaria post-mastectomía en el sistema sanitario público de Andalucía

ABSTRACT Background: Breast reconstruction (BR) after mastectomy is widely recommended but there are significant variations in its application. The objective was to know the rate of BR in the Andalusian Public Health System (APHS), timing (immediate or delayed), surgical procedure, frecuency of postoperative complications and their characteristics. Methods: We used the Minimum Basic Data Set of the APHS with personal data and identification of hospitals encrypted. We selected discharges for breast cancer and mastectomy in 2010-2013 and related readmissions of the same patients in 2010-2014. BR rates were calculated according to patient age and type of mastectomy. Timing of BR (immediate or delayed) and surgical techniques used were described. Postoperative complications were analyzed in the initial episode and in readmissions occurring within a minimum period of 2 years. BR failures were specifically studied. Results: We analyzed the information of 6,026 women, of which 4,412 met the inclusion criteria (basically, two years follow-up). The BR rate was 29% (22% immediate and 7% delayed) and reached 58% in women younger than 46 years. BR was performed by 27 of the 36 hospitals that practice mastectomies. Global percentage of postoperative complications was 18.6% for immediate BR, 12.1% for delayed BR and 7.9% for patients without BR. Failure occurred in 12.7% of immediate BR and 7.2% of delayed BR. Conclusions: In the Andalusian Public Health System the Breast reconstruction rate, is at a similar level to that reported nationally and in other countries. RESUMEN Fundamento: La reconstrucción mamaria (RM) post-mastectomía está ampliamente recomendada pero hay importantes variaciones en su aplicación. El objetivo fue conocer la frecuencia de complicaciones postoperatorias en el Sistema Sanitario Público de Andalucía (SSPA), el momento de su realización (inmediata o diferida), las técnicas aplicadas, la frecuencia de reingresos por complicaciones postoperatorias y sus características. Métodos: Se utilizó el Conjunto Mínimo Básico de Datos del SSPA con los datos identificativos de pacientes y hospitales encriptados. Se seleccionaron las altas por cáncer de mama y mastectomía de 2010-2013 y los reingresos relacionados de las mismas mujeres de 2010-2014. Se calcularon las tasas de RM según edad y tipo de mastectomía. Se describió el momento de su realización (inmediata o diferida) y las técnicas quirúrgicas empleadas. Las complicaciones postoperatorias se analizaro