One Year Outcomes of the Mastectomy Reconstruction Outcomes Consortium (MROC) Study Part I: Complications
Edwin G. Wilkins, MD MS1, Andrea L. Pusic, MD MHS2, H. Myra Kim, ScD1, Jennifer B. Hamill, MPH1, Ji Qi, MS1.
1University of Michigan, Ann Arbor, MI, USA, 2Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
Part I: Complications
Purpose: In post-mastectomy reconstruction, procedure choice is heavily influenced by the relative risks of the various options. We evaluated complications in a large, multicenter population of breast reconstruction patients.
Methods: Eleven sites enrolled women undergoing first time, immediate or delayed reconstruction following mastectomy for cancer treatment or prophylaxis. Procedures included implant-based, lat. dorsi (LD), pedicle TRAM (PTRAM), free TRAM (FTRAM) and DIEP reconstructions. Clinical and demographic data were gathered pre- and post-operatively from medical records. Separate logistic regressions were conducted for all complications and major complications (requiring rehospitalization and/or reoperation) within one year. Odds ratios were calculated for procedure, controlling for site, demographic and clinical variables.
Results: Complication rates for 1895 patients are summarized below. Regression indicated that compared with implant-based reconstruction, LD (OR=2.02,p=0.032), PTRAM (OR=1.96,p=0.028), FTRAM (OR=2.24,p=0.004), and DIEP (OR=2.19,p<0.0001) procedures were associated with higher risks of complications. Significantly higher risks were also associated with older age, higher BMI, immediate reconstruction, bilateral procedures, and radiation. For major complications, regression showed significantly greater risks for FTRAM (OR=2.07,p=0.016) and DIEP (OR=1.76,p=0.011), compared with implant-based reconstructions. Significant effects were noted for age, BMI, laterality, and radiation.
Conclusion: In this multicenter study, procedure choice and other patient variables were significant predictors of one-year complications. These findings should be considered in counselling patients on breast reconstruction options.
|Procedure||Any Complication||Major Complications (Including Failures)||Failures||Sub-total|
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