TY - JOUR
T1 - The differential effect of BMI on prosthetic versus autogenous breast reconstruction
T2 - A multivariate analysis of 12,986 patients
AU - Hanwright, Philip J.
AU - Davila, Armando A.
AU - Hirsch, Elliot M.
AU - Khan, Seema A.
AU - Fine, Neil A.
AU - Bilimoria, Karl Y.
AU - Kim, John Y.S.
N1 - Funding Information:
John YS Kim is a consultant for and receives research funding from Mentor and the Musculoskeletal Transplant Foundation. Neil Fine receives research funding from Allergan. The remaining authors have nothing to disclose.
PY - 2013/10
Y1 - 2013/10
N2 - Background: The comparative safety of breast reconstruction in obese patients remains to be clearly defined. This study utilized multi-institutional data to characterize the effect of body mass index (BMI) on breast reconstruction outcomes. Methods: Utilizing Current Procedural Terminology (CPT) codes, patients undergoing tissue expander, pedicled transverse rectus abdominis myocutaneous (TRAM) flap, latissimus dorsi flap, and free flap breast reconstruction were identified in the National Surgical Quality Improvement Program (NSQIP) database. Patients were stratified as obese (BMI≥30) and non-obese (BMI<30). Overall postoperative morbidity, flap complications, non-flap complications, and reoperation rates were compared among the groups. Results: Of 12,986 patients who underwent breast reconstruction, 3636 (28.0%) were obese. Overall morbidity was significantly elevated in obese patients across all forms of reconstruction ( p<0.05). BMI was correlated with increased surgical complications for tissue expander, pedicled TRAM, and free flap reconstructions (OR=1.09, OR=1.05, OR=1.10, respectively; p<0.05). Medical complications were higher in obese patients undergoing tissue expander and pedicled TRAM reconstructions ( p=0.001 and p<0.001), but no significant difference was observed in latissimus and free flap reconstruction patients. Compared with obese tissue expander recipients, obese patients reconstructed using autologous tissue had higher rates of reoperations (12.8% versus 9.1%), overall morbidity (18.0% versus 9.5%), surgical (12.7% versus 8.3%), and medical complications (9.0% versus 2.2%). Conclusions: The NSQIP database allows for evaluation and comparison of reconstructive outcomes in the obese population. Increased BMI was associated with higher morbidity in autologous reconstruction than tissue expander reconstruction. Among autologous procedures, latissimus flaps experienced the lowest captured 30 day morbidity.
AB - Background: The comparative safety of breast reconstruction in obese patients remains to be clearly defined. This study utilized multi-institutional data to characterize the effect of body mass index (BMI) on breast reconstruction outcomes. Methods: Utilizing Current Procedural Terminology (CPT) codes, patients undergoing tissue expander, pedicled transverse rectus abdominis myocutaneous (TRAM) flap, latissimus dorsi flap, and free flap breast reconstruction were identified in the National Surgical Quality Improvement Program (NSQIP) database. Patients were stratified as obese (BMI≥30) and non-obese (BMI<30). Overall postoperative morbidity, flap complications, non-flap complications, and reoperation rates were compared among the groups. Results: Of 12,986 patients who underwent breast reconstruction, 3636 (28.0%) were obese. Overall morbidity was significantly elevated in obese patients across all forms of reconstruction ( p<0.05). BMI was correlated with increased surgical complications for tissue expander, pedicled TRAM, and free flap reconstructions (OR=1.09, OR=1.05, OR=1.10, respectively; p<0.05). Medical complications were higher in obese patients undergoing tissue expander and pedicled TRAM reconstructions ( p=0.001 and p<0.001), but no significant difference was observed in latissimus and free flap reconstruction patients. Compared with obese tissue expander recipients, obese patients reconstructed using autologous tissue had higher rates of reoperations (12.8% versus 9.1%), overall morbidity (18.0% versus 9.5%), surgical (12.7% versus 8.3%), and medical complications (9.0% versus 2.2%). Conclusions: The NSQIP database allows for evaluation and comparison of reconstructive outcomes in the obese population. Increased BMI was associated with higher morbidity in autologous reconstruction than tissue expander reconstruction. Among autologous procedures, latissimus flaps experienced the lowest captured 30 day morbidity.
KW - BMI
KW - Body mass index
KW - Breast reconstruction
KW - Complication
KW - Flap
KW - Implant
KW - Microvascular
KW - Pedicle
KW - Tissue expander
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U2 - 10.1016/j.breast.2013.05.009
DO - 10.1016/j.breast.2013.05.009
M3 - Article
C2 - 23769660
AN - SCOPUS:84884167247
SN - 0960-9776
VL - 22
SP - 938
EP - 945
JO - Breast
JF - Breast
IS - 5
ER -