Frail but resilient: Frailty in autologous breast reconstruction is associated with worse surgical outcomes but equivalent long-term patient-reported outcomes Journal Article
| Authors: | Hassan, A. M.; Paidisetty, P.; Ray, N.; Govande, J. G.; Nelson, J. A.; Mehrara, B. J.; Butler, C. E.; Mericli, A. F.; Selber, J. C. |
| Article Title: | Frail but resilient: Frailty in autologous breast reconstruction is associated with worse surgical outcomes but equivalent long-term patient-reported outcomes |
| Abstract: | Background: Frailty is associated with higher risk of complications following breast reconstruction, but its impact on long-term surgical and patient-reported outcomes has not been investigated. We examined the association of the five-item modified frailty index (MFI) score with long-term surgical and patient-reported outcomes in autologous breast reconstruction. Patients and Methods: We conducted a retrospective cohort study of consecutive patients who underwent mastectomy and autologous breast reconstruction between January 2016 and April 2022. Primary outcome was any flap-related complication. Secondary outcomes were patient-reported outcomes and predictors of complications in the frail cohort. Results: We identified 1640 reconstructions (mean follow-up 24.2 ± 19.2 months). In patients with MFI ≥ 2, the odds of surgical [odds ratio (OR) 2.13, p = 0.023] and medical (OR 17.02, p < 0.001) complications were higher than in nonfrail patients. We found no significant difference in satisfaction with the breast (p = 0.287), psychosocial well-being (p = 0.119), or sexual well-being (p = 0.314) according to MFI score. Chronic obstructive pulmonary disease was an independent predictor of infection (OR 3.70, p = 0.002). Tobacco use (OR 7.13, p = 0.002) and contralateral prophylactic mastectomy (OR 2.36, p = 0.014) were independent predictors of wound dehiscence. Dependent functional status (OR 2.36, p = 0.007) and immediate reconstruction (compared with delayed reconstruction; OR 3.16, p = 0.026) were independent predictors of skin flap necrosis. Dependent functional status was also independently associated with higher odds of reoperation (OR 2.64, p = 0.011). Conclusion: Frailty is associated with higher risk of complications in breast reconstruction, but there is no significant difference in long-term patient-reported outcomes. MFI should be considered in breast reconstruction to improve outcomes in high-risk frail patients. © 2023, Society of Surgical Oncology. |
| Keywords: | adult; controlled study; treatment outcome; aged; middle aged; patient satisfaction; retrospective studies; major clinical study; comparative study; outcome assessment; follow up; antineoplastic agent; quality of life; breast cancer; mastectomy; cohort analysis; psychology; deep vein thrombosis; breast neoplasms; breast reconstruction; mammaplasty; graft necrosis; latissimus dorsi flap; retrospective study; risk factor; pneumonia; lung embolism; postoperative complication; postoperative complications; acute kidney failure; graft failure; adverse outcome; heart infarction; vein thrombosis; breast tumor; operation duration; therapy delay; reoperation; surgical infection; urinary tract infection; comorbidity; predictor variable; cross-sectional study; hospital readmission; patient reported outcome measures; deep inferior epigastric perforator flap; transverse rectus abdominis musculocutaneous flap; hematoma; seroma; superficial inferior epigastric artery flap; wound healing impairment; frail elderly; wound dehiscence; nipple-sparing mastectomy; skin-sparing mastectomy; functional status; artery thrombosis; chronic obstructive lung disease; cerebrovascular accident; tissue flap; surgical patient; tobacco use; abdominal wall hernia; prophylactic mastectomy; contralateral prophylactic mastectomy; complication; peroperative complication; patient-reported outcome; preoperative chemotherapy; independent variable; thoracodorsal artery perforator flap; frailty; breast-q; humans; human; female; article; psychological resilience; simple mastectomy; functional status assessment; autologous breast reconstruction; profunda artery perforator flap; modified frailty index; social well-being; sexual well-being; psychological resilience scale; abdominal bulge |
| Journal Title: | Annals of Surgical Oncology |
| Volume: | 31 |
| Issue: | 1 |
| ISSN: | 1068-9265 |
| Publisher: | Springer |
| Date Published: | 2024-01-01 |
| Start Page: | 659 |
| End Page: | 671 |
| Language: | English |
| DOI: | 10.1245/s10434-023-14412-4 |
| PUBMED: | 37864119 |
| PROVIDER: | scopus |
| DOI/URL: | |
| Notes: | Article -- Source: Scopus |
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