Risk Analysis and Stratification of Surgical Morbidity after Immediate Breast Reconstruction
- 10 July 2013
- journal article
- Published by Ovid Technologies (Wolters Kluwer Health) in Journal of the American College of Surgeons
- Vol. 217 (5), 780-787
- https://doi.org/10.1016/j.jamcollsurg.2013.07.004
Abstract
Surgical complications after breast reconstruction can be associated with significant morbidity, dissatisfaction, and cost. We used the ACS-NSQIP datasets from 2005 to 2011 to derive predictors of morbidity and to stratify risk after immediate breast reconstruction (IBR). Surgical complications after implant and autologous reconstruction were assessed using the ACS-NSQIP 2005 to 2011 datasets. Patient demographics, clinical characteristics, and operative factors were associated with the likelihood of experiencing a surgical complication. A “model cohort” of 12,129 patients was randomly selected from the study cohort to derive predictors. Weighted odds ratios derived from logistic regression analysis were used to create a composite risk score and to stratify patients. The remaining one-third of the cohort (n = 6,065) were used as the “validation cohort” to assess the accuracy value of the risk model. On adjusted analysis, autologous reconstruction (odds ratio [OR] 1.41, p < 0.001), American Society of Anesthesiologists physical status ≥ 3 (OR 1.25, p = 0.004), class I obesity (OR 1.38, p < 0.001), class II obesity (OR 1.91, p < 0.001), class III obesity (OR 1.70, p < 0.001), and active smoking (OR 1.46, p < 0.001) were associated with complications. Risk factors were weighted and patients were stratified into low (0 to 2, n = 9,133, risk = 7.14%), intermediate (3 to 4, n = 1,935, risk = 10.90%), high (5 to 7, n = 1,024, risk = 16.70%), and very high (8 to 9, n = 37, risk = 27.02%) risk categories based on their total risk score (p < 0.001). Internal validation of the “model cohort” using the “validation cohort” was performed demonstrating accurate prediction of risk across groups: low (7.1% vs 7.1%, respectively, p = 0.9), intermediate (10.9% vs 12.0%, respectively, p = 0.38), high (16.7% vs 16.8%, respectively, p = 0.95), and very high (27.0% vs 30.0%, respectively, p = 1.0). Surgical complications after IBR are related to preoperatively identifiable factors that can be used to accurately risk stratify patients, which may assist with counseling, selection, and perioperative decision-making.Keywords
This publication has 37 references indexed in Scilit:
- Direct-to-Implant Breast ReconstructionClinics in Plastic Surgery, 2012
- Patient satisfaction and health‐related quality of life after autologous tissue breast reconstructionCancer, 2011
- Development of a New Patient-Reported Outcome Measure for Breast Surgery: The BREAST-QPlastic and Reconstructive Surgery, 2009
- Risk Factors for Surgical Site Infection after Major Breast OperationJournal of the American College of Surgeons, 2008
- A Prospective Assessment of Surgical Risk Factors in 400 Cases of Skin-Sparing Mastectomy and Immediate Breast Reconstruction with Implants to Establish Selection CriteriaPlastic and Reconstructive Surgery, 2007
- Complications after Microvascular Breast Reconstruction: Experience with 1195 FlapsPlastic and Reconstructive Surgery, 2006
- A Single Surgeon???s 12-Year Experience with Tissue Expander/Implant Breast Reconstruction: Part I. A Prospective Analysis of Early ComplicationsPlastic and Reconstructive Surgery, 2006
- An Outcome Study of Breast Reconstruction: Presurgical Identification of Risk Factors for ComplicationsAnnals of Surgical Oncology, 2001
- Determinants of Patient Satisfaction in Postmastectomy Breast ReconstructionPlastic and Reconstructive Surgery, 2000
- Overweight and obesity in the United States: prevalence and trends, 1960–1994International Journal of Obesity, 1997