title: Donor-Site Hernia Repair in Abdominal Flap Breast Reconstruction: A Population-Based Cohort Study of 7929 Patients.
abstract: BACKGROUND
  The authors investigated hernia repair rates following pedicled transverse rectus abdominis myocutaneous (TRAM), free TRAM, and deep inferior epigastric perforator (DIEP) flap breast reconstruction in English National Health Service hospitals.
  
  
  METHODS
  Women diagnosed with breast cancer who underwent pedicled TRAM, free TRAM, or DIEP flap breast reconstruction procedures in English National Health Service hospitals between April of 2006 and March of 2012 were identified using the Hospital Episode Statistics database. Women who underwent mastectomy without reconstruction acted as controls, and hernia repair rates were calculated for all four groups. Multiple Cox regression was performed to estimate the relative risk of hernia repair among the reconstruction groups, adjusted for age, obesity, previous abdominal surgery, reconstruction year, and bilateral flap harvest.
  
  
  RESULTS
  Between 2006 and 2012, 7929 women had a DIEP or TRAM flap breast reconstruction. The overall hernia repair rate within 3 years was 2.45 percent after abdominal flap breast reconstruction, and 0.28 percent among the 15,679 women who had mastectomy only. Mean time to hernia repair following an abdominal flap harvest was 17.7 months. Compared with DIEP flaps, free and pedicled TRAM flap procedures were associated with adjusted hazard ratios of 1.81 (95 percent CI, 1.24 to 2.64) and 2.89 (95 percent CI, 1.91 to 4.37), respectively. The only independent risk factor for hernia repair was age older than 60 years (p = 0.039).
  
  
  CONCLUSIONS
  Abdominally based autologous breast reconstruction carries a small risk of subsequent donor-site hernia repair. The rates herein can be used to inform patients and to assess quality of care across service providers.
  
  
  METHODS
  Therapeutic, III.
authors.affiliation: London, Newcastle upon Tyne, and Winchester, United Kingdom From the Clinical Effectiveness Unit, Royal College of Surgeons of England; Department of Plastic and Reconstructive Surgery, Guy's and St Thomas Hospital; Department of Plastic and Reconstructive Surgery, Royal Victoria Infirmary, Newcastle upon Tyne National Health Service Foundation Trust; Department of Breast Surgery, Royal Hampshire County Hospital; and Department of Health Services Research & Policy, London School of Hygiene & Tropical Medicine.
authors.forename: Joanna C
authors.initials: JC
authors.lastname: Mennie
authors.forename: Pari-Naz
authors.initials: PN
authors.lastname: Mohanna
authors.forename: Joe M
authors.initials: JM
authors.lastname: O'Donoghue
authors.forename: Richard
authors.initials: R
authors.lastname: Rainsbury
authors.forename: David A
authors.initials: DA
authors.lastname: Cromwell
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000601:surgery*; D005260:Female; D046449:Hernia, Abdominal / Q000209:etiology / Q000601:surgery*; D059685:Herniorrhaphy / Q000706:statistics & numerical data*; D006801:Humans; D053208:Kaplan-Meier Estimate; D016462:Mammaplasty / Q000379:methods*; D008408:Mastectomy; D008875:Middle Aged; D011183:Postoperative Complications / Q000601:surgery*; D016016:Proportional Hazards Models; D017568:Rectus Abdominis; D012189:Retrospective Studies; D012307:Risk Factors; D013524:Surgical Flaps; D055815:Young Adult
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