Predicting complications following expander/implant breast reconstruction: An outcomes analysis based on preoperative clinical risk Journal Article
| Authors: | McCarthy, C. M.; Mehrara, B. J.; Riedel, E.; Davidge, K.; Hinson, A.; Disa, J. J.; Cordeiro, P. G.; Pusic, A. L. |
| Article Title: | Predicting complications following expander/implant breast reconstruction: An outcomes analysis based on preoperative clinical risk |
| Abstract: | BACKGROUND: Complications following postmastectomy reconstruction can cause significant morbidity. The compound effect of individual risk factors on the development of complications following expander/implant reconstruction has not, however, been well delineated. This study evaluated the impact of clinical risk factors to predict complications following postmastectomy expander/implant reconstruction. METHODS: From 2003 through 2004, 1170 expander/implant reconstructions were performed at a single center. A prospectively maintained database was reviewed. Variables including age, smoking status, body mass index, history of diabetes, hypertension, chemotherapy and/or radiation, as well as timing and laterality of reconstruction were evaluated. The primary endpoint was the development of a complication; the secondary endpoint was failure of reconstruction. RESULTS: Over the 2 year study period, 1170 expander/implant reconstructions were performed in 884 patients. The odds of developing complications was 2.2 times greater in smokers (p < 0.001) and 2.5 times greater in women over 65 (p = 0.008). Patients who were obese were at nearly two times the odds of having complications (p = 0.02), as were patients with hypertension (p = 0.02). Similarly, the odds of reconstructive failure were five times greater in smokers (p < 0.001). Age was not a significant predictor of reconstructive failure (p = 0.09); yet, failure was nearly seven times greater in obese patients (p < 0.001), and four more times likely in those who were hypertensive (p = 0.005). CONCLUSIONS: Smoking, obesity, hypertension, and age over 65 were independent risk factors for perioperative complications following expander/implant breast reconstruction. Smoking, obesity, and hypertension were similarly associated with reconstructive failure. This information can be used to evaluate overall procedural risks and individualize reconstructive options. Copyright © 2008 by the American Society of Plastic Surgeons. |
| Keywords: | adult; cancer chemotherapy; controlled study; treatment outcome; aged; middle aged; implant; treatment failure; retrospective studies; major clinical study; anamnesis; postoperative period; hypertension; adjuvant therapy; cancer radiotherapy; preoperative care; outcome assessment; follow up; methodology; follow-up studies; antineoplastic agent; preoperative evaluation; cohort studies; mastectomy; logistic models; incidence; cohort analysis; odds ratio; obesity; breast neoplasms; breast reconstruction; mammaplasty; data base; graft necrosis; retrospective study; tissue expansion devices; risk assessment; risk; postoperative complication; postoperative complications; body mass; breast tumor; diabetes mellitus; surgical risk; prediction and forecasting; predictive value of tests; postoperative infection; smoking habit; multivariate analysis; age distribution; breast endoprosthesis; esthetics; breast implants; hematoma; seroma; analysis of variance; statistical model; breast augmentation; breast implantation |
| Journal Title: | Plastic and Reconstructive Surgery |
| Volume: | 121 |
| Issue: | 6 |
| ISSN: | 0032-1052 |
| Publisher: | Lippincott Williams & Wilkins |
| Date Published: | 2008-06-01 |
| Start Page: | 1886 |
| End Page: | 1892 |
| Language: | English |
| DOI: | 10.1097/PRS.0b013e31817151c4 |
| PUBMED: | 18520873 |
| PROVIDER: | scopus |
| DOI/URL: | |
| Notes: | --- - "Cited By (since 1996): 24" - "Export Date: 17 November 2011" - "CODEN: PRSUA" - "Source: Scopus" |
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