深部下腹动脉穿支皮瓣（DIEP）是自体乳房重建的黄金标准。本研究调查了一个大型的现代队列中DIEP并发症的危险因素，以优化手术评估和规划。这项回顾性研究包括在一所学术机构进行DIEP乳房重建手术的患者，时间从2016年至2020年。单变量和多变量回归模型评估了人口统计学、治疗和结果与术后并发症的关系。 总共在524名患者中进行了802个DIEP皮瓣 (平均年龄51.2±9.6岁，平均BMI29.3±4.5）。大多数（87％）患者患有乳腺癌，15％为BRCA阳性。其中282名（53％）为延迟性重建，242名（46％）为即刻重建；278名（53％）为双侧重建，246名（47％）为单侧重建。总体并发症发生在81名（15.5％）患者中，包括静脉淤血（3.4％）、乳房血肿（3.6％）、感染（3.6％）、部分皮瓣丢失（3.2％）、完全皮瓣丢失（2.3％）和动脉血栓形成（1.3％）。手术时间延长与双侧即刻重建和较高的BMI显著相关。手术时间延长（OR=1.16，p=0.001）和即刻重建（OR=1.92，p=0.013）是总体并发症的显著预测因素。部分皮瓣丢失与双侧即刻重建、较高的BMI、目前吸烟状态和手术时间延长有关。 手术时间延长是DIEP乳房重建总体并发症和部分皮瓣丢失的显著危险因素。每增加一小时手术时间，发生总体并发症的风险增加16%。这些发现表明，通过联合外科医生、手术团队的一致性和将更多危险因素的患者咨询向延迟性重建，可以减少手术时间，从而减轻并发症。版权所有 ©2023年美国整形外科医师协会。

Deep inferior epigastric perforator (DIEP) flaps are the gold-standard for autologous breast reconstruction. This study investigated risk factors for DIEP complications in a large, contemporary cohort to optimize surgical evaluation and planning.This retrospective study included patients who underwent DIEP breast reconstruction between 2016-2020 at an academic institution. Demographics, treatment, and outcomes were evaluated in univariable and multivariable regression models for postoperative complications.In total, 802 DIEP flaps were performed in 524 patients (mean age 51.2±9.6, mean BMI 29.3±4.5). Most (87%) patients had breast cancer, and 15% were BRCA-positive. There were 282 (53%) delayed and 242 (46%) immediate reconstructions, and 278 (53%) bilateral and 246 (47%) unilateral reconstructions. Overall complications occurred in 81 (15.5%) patients, including venous congestion (3.4%), breast hematoma (3.6%), infection (3.6%), partial flap loss (3.2%), total flap loss (2.3%), and arterial thrombosis (1.3%). Longer operative time was significantly associated with bilateral immediate reconstructions and higher BMI. Prolonged operative time (OR=1.16, p=0.001) and immediate reconstruction (OR=1.92, p=0.013) were significant predictors of overall complications. Partial flap loss was associated with bilateral immediate reconstructions, higher BMI, current smoking status, and longer operative time.Prolonged operative time is a significant risk factor for overall complications and partial flap loss in DIEP breast reconstruction. For each additional hour of surgical time, the risk of developing overall complications increases by 16%. These findings suggest that reducing operative time through co-surgeon approaches, consistency in surgical teams, and counseling patients with more risk factors towards delayed reconstructions may mitigate complications.Copyright © 2023 by the American Society of Plastic Surgeons.