Added Risk in Patients Undergoing Matching Procedures at Time of Immediate Breast Reconstruction: An ACS-NSQIP Study of 24,191 Patients
Mohamad E. Sebai, MBBS, Carisa Cooney, MPH, Buchi Ogbuagu, MD, MPH, Pablo A. Baltodano, MD, Chris Devulapalli, MD, Michele Manahan, MD, Gedge Rosson, MD.
Johns Hopkins, Baltimore, MD, USA.
Purpose: To assess for compounded risk of postoperative morbidity with the addition of a contralateral breast matching procedures (MP) at time of mastectomy in patients undergoing immediate breast reconstruction.
Methods: We used the 2005-2012 ACS-NSQIP databases to identify patients who underwent mastectomy and immediate breast reconstruction with and without concurrent contralateral breast MPs. MPs included mastopexy, reduction mammoplasty, and augmentation mammoplasty. Univariable logistic regression was used to compare MP and no-MP groups to estimate odds ratios (OR) of 30-day postoperative overall, systemic, and surgical site morbidity.
Results: Out of 59,766 mastectomy patients, 24,191(40%) had immediate breast reconstruction: 903 (3.7%) underwent MPs and 23,288 (96.3%) did not. After univariable logistic regression, the MP group demonstrated statistically significantly higher overall morbidity (OR 1.288, 95% CI=1.022-1.623, p=0.032). Although surgical site and systemic morbidity did not differ significantly, the MP group demonstrated higher risk for superficial surgical site infection (OR 1.57, 95% CI=1.066-2.31, p=0.022), reconstruction failure (OR 1.69, 95% CI=1.014-2.814, p=0.044) and pulmonary embolism (OR 2.54, 95% CI=1.01-6.37, p=0.048).
Conclusion: Patients who underwent mastectomy with immediate breast reconstruction and concurrent MPs demonstrated higher overall morbidity rates in comparison with no-MP patients. Superficial surgical site infection, reconstruction failure, and pulmonary embolism were statistically significantly higher in the MP group. Since pulmonary embolism is an Agency for Healthcare Research and Quality Patient Safety Indicator, this is a critical finding. These data suggest that surgeons should counsel patients interested in undergoing concurrent MPs about increased risks of developing these complications postoperatively.
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