Preventing Early Complications Following Oncologic Breast Surgery: The NDoCaSco Score for Targeted Negative-Pressure...

Background: Thanks to its capacity to increase wound healing, NPWD (Negative-Pressure Wound Dressing) showed promising results in breast surgery. The authors developed the NDoCaSco system for select patients that may benefit the most from NPWD after breast oncologic surgery, aiming to improve outcomes in patients at risk for wound dehiscence and breast reconstruction failure. Methods: Patients scheduled for breast oncologic surgery were enrolled between 2022 and 2023. Surgical wound dressing was selected prior to assessing the risk for post-operative complications with the NDoCaSco. Low-risk patients (NDoCaSco score: 15-21) received traditional compressive dressing, while moderate- (NDoCaSco: 8-14) and high-risk (NDoCaSco: 0-7) patients received short-term or long-term NPWD, respectively. Results: Healing time and outcomes were compared to a retrospective control group that underwent the same surgeries between 2019 and 2021 and received traditional compressive wound dressing in all cases. The study population included 739 patients with an average age of 62.3 years (range, 29-95) and a mean BMI of 25.2 kg/m² (range, 16-46). Breast-conserving surgery was performed in 437 cases, and 302 received mastectomy with implant-based reconstruction. A total of 152 patients scored medium (140 cases) or low (12 cases) NDoCaSco and received NPWD. Post-operative complications' incidence, healing time, and drain removal time were lower in the study group, while scar quality was consistently improved with NPWD when comparing the two middle-risk groups. Conclusions: NDoCaSco helped in identifying patients who benefit the most from NPWD, achieving faster healing and reduction in outpatient visits and hospital admissions, leading to a lower expenditure of resources.