Patient Shared Decision-Making in Deep Inferior Epigastric Perforator (DIEP) Flap Donor Site Complications: A Patient Centric Classification Validated by BREAST-Q Improves Satisfaction

Abstract

Abstract Title: Patient Shared Decision-Making in DIEP Flap Donor Site Complications: A Patient Centric Classification Validated by BREAST-Q Improves Satisfaction Background The body of literature on abdominal donor site complications after DIEP flap breast reconstruction lacks standardization. The aim of this study is to standardize reporting of abdominal donor site complications and report on patient satisfaction based on shared decision-making of treatment outcomes. Methods This retrospective study was conducted on patients who underwent DIEP flap breast reconstruction between January 2011 to December 2021 performed by the senior authors. Patients were excluded if they had prior significant abdominal surgeries, post-reconstruction radiation, or if underwent a concomitant autologous flap reconstruction. Primary outcomes included abdominal donor site complications, treatment outcomes, and BREAST-Q questionnaire responses. Categorical outcomes were compared between groups using Chi-squared test or Fisher-exact test, and strength of association using Phi or Cramer’s V when appropriate, while continuous outcomes were compared using independent-samples t-test. A binomial logistic regression was performed to ascertain the effects of covariates on the likelihood complication outcomes. Results Five hundred two patients were evaluated. The patient complication rate was 35.3%. Complications were comprised of 68.1% (n = 205) minor complications and 31.9% (n = 96) major complications. A moderately strong association was noted between history of DVT/PE and major complications, φ = 0.174, p < 0.001. There was a near significant association between umbilical preservation and minor complications, φ = 0.086, p = 0.055. In the logistic regression BMI, hypertension, and umbilical preservation were associated with increased minor complications, while BMI, race, hypertension, and history of DVT/PE were associated with increased risk of major complications. Patient cohort reported higher postoperative psychosocial well-being in minor complications (80.49, EMM) while higher postoperative abdominal well-being in no complications (73.50, EMM). Conclusion This study standardizes abdominal donor site complications after DIEP flap breast reconstruction which aids in the effort of communicating clearly with patients as a part of shared decision-making, and leads to improved patient satisfaction and understanding.