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Analysis of Complications After Breast Reduction Surgery - 3,538 Reductions from the 2005-2010 NSQIP Datasets
John P. Fischer, MD, Eric Shang, MD, Jonas A. Nelson, MD, Liza C. Wu, MD, Joseph M. Serletti, MD.
Hospital of the Univesity of Pennsylvania, Philadelphia, PA, USA.
Reduction mammaplasty is a well-established and effective surgical technique to treat symptomatic macromastia, and represents one of the most commonly performed surgical procedures by plastic surgeons in the US. Conflicting reports cite variable rates of complications and identify different risk factors associated with complications and morbidity. Thus, there is a continued need for outcome assessment studies, particularly from well-controlled large datasets. In this current study we characterize predictors of post-operative complications following reduction mammaplasty using the ACS-NSQIP databases.
We reviewed the 2005-2010 ACS-NSQIP databases identifying encounters for CPT codes (19318) for reduction mammaplasty. We identified surgical complications using defined NSQIP variables, including: surgical site infection, wound dehiscence, deep infection, and return to operating room. We specifically defined two complications: major complications (deep infection and return to OR) and any complication (all surgical complications). A variety of preoperative patient factors and co-morbidities, as well as intra-operative variables were compared. Patients experiencing complications were compared to those who did not. Exploratory univariate analyses were performed and regression analysis was used to identify predictors of complications.
A total of 3,538 patients were identified with an average age of 43 years and BMI of 31.6 kg/m2 were included in the study. The majority of patients underwent outpatient surgery (80.5%) with an average operative time of 180 minutes. The incidence of overall surgical complications was 5.1%. The following factors were independently associated with surgical complications: morbid obesity (OR=2.1, P<0.001), active smoking (OR=1.7, P<0.001), history of dyspnea (OR=2.0, P<0.001), and resident participation (OR=1.8, P=0.01). The incidence of major surgical complications was 2.1%. Factors associated with such complications included smoking (OR=2.7, P<0.001), dyspnea (OR=2.6, P<0.001), resident participation (2.1, P<0.001), and inpatient surgery (OR=1.8, P=0.01).
This study characterizes post-operative surgical complications following reduction mammaplasty in very larg cohort of patients derived from a prospective national registry. We report an overall incidence of complications in 1 in 20 patients and a 1 in 50 incidence of a major complication. These data can be used in preoperative discussions with patients. We have additionally identified several independent risk factors associated with surgical complications, including smoking, obesity, dyspnea, and resident participation. Modifiable factors associated with both surgical complications and major complications such as obesity, smoking, and respiratory function present new opportunities to risk stratify and select patients. These data can assist the reconstructive surgeon and enhance peri-operative decision-making.
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