Complications and morbidity following breast reconstruction – a review of 16,063 cases from the 2005–2010 NSQIP datasets

Abstract

Post-operative complications pose a significant set-back for patients undergoing breast reconstruction. This study aims to characterize factors associated with postoperative complications following breast reconstruction using the National Surgical Quality Improvement Program (ACS-NSQIP) database from 2005-2010. The 2005-2010 ACS-NSQIP databases were reviewed, identifying encounters for CPT codes including either implant-based reconstruction (immediate, delayed, and tissue expander) or autologous reconstruction (pedicled transverse rectus abdominus myocutaneous (TRAM), free TRAM, and latissimus dorsi flap with or without implant). Complications were characterized into three categories: major surgical complications, wound complications, and medical complications. During the study period 16,063 breast reconstructions were performed. Autologous reconstructions were performed in 20.7% of patients and implant-based in 79.3%. The incidence of major surgical complications was 8.4%, whereas the incidence of medical and wound complications was 1.6% and 3.5%, respectively. Independent risk factors for major surgical complications included: immediate and autologous reconstructions, obesity, smoking, previous percutaneous cardiac surgery (PCS), recent weight loss, bleeding disorder, recent surgery, ASA ≥ 3, intra-operative transfusion, and prolonged operative times. Risk factors for medical complications included: autologous reconstruction, obesity, tumor involving CNS, bleeding disorders, recent surgery, ASA ≥ 3, intra-operative transfusion, and prolonged operative times. This study characterizes the incidence of surgical and medical complications following breast reconstruction using a large, prospective multicentre dataset. Key identifiable risk factors associated with both surgical and medical morbidity included: autologous breast reconstruction, obesity, ASA ≥ 3, bleeding disorders, and prolonged operative time. Data derived from this cohort can be used to risk-stratify patients and to enhance perioperative decision-making.

Patient determinants as independent risk factors for postoperative complications of breast reconstruction

“…Significant independent risk factors have been previously identified, both in plastic surgery and in other specialities (40,44,45,50,72,(83)(84)(85)(86)(87)(88)(89)(90)(91)(92)(93). However, the advantage of the present study is the evaluation of four different reconstruction methods with the same criteria for complications.…”

A Comparison of Perioperative Blood Transfusions and Other Complications Following Transverse Rectus Abdominis Myocutaneous Flaps versus Deep Inferior Epigastric Perforator Flaps

“…Abdominal based free flaps such as the Transverse Rectus Abdominis Myocutaneous (TRAM) flap and Deep Inferior Epigastric Perforator (DIEP) flap are essential tools in the reconstructive armamentarium post mastectomy. These are often prolonged, complex procedures which can result in more complications than other reconstructive options [6]. Research comparing the two approaches seems to indicate that each method has its strengths and weaknesses.…”

A propensity score matched analysis of obesity as an independent risk factor for postoperative complications in reduction mammaplasty

“…[26] Like other NSQIP-based analyses of reduction mammaplasty, there are limitations to this study. [6,27] Follow-up was only 30 days, a relatively short period of time. NSQIP does not include complications such as seroma, hematoma, fat necrosis, altered nipple sensation, aesthetic outcomes, or hypertrophic scarring.…”