The Association Between Metabolic Derangement and Wound Complications in Elective Plastic Surgery

Sergesketter, Amanda R.; Geng, Yisong; Shammas, Ronnie L.; Denis, Gerald V.; Bachelder, Robin E.; Hollenbeck, Scott T.

doi:10.1016/j.jss.2022.03.017

Cited by 11 publications

(9 citation statements)

References 47 publications

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“…There is also some discordance between our propensity-matched analysis of rates of fluid formation (hematoma, seroma) when compared with our multivariate analysis, which showed that smoking is significantly associated with increased risk of seroma formation, specifically that being a current smoker confers a 120 times increased likelihood. Previous studies have noted an increased risk of complications with patients who are smokers 36 …”

Section: Discussionmentioning

confidence: 99%

A Propensity Score–Matched Comparison of Perioperative Outcomes in Prepectoral Smooth Versus Textured Tissue Expander Breast Reconstruction

et al. 2023

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Introduction Textured tissue expanders (TEs) had previously gained popularity due to minimizing expander migration, rotation, and capsule migration. Recent studies, though, have revealed increased risk of anaplastic large-cell lymphoma associated with certain macrotextured implants, prompting surgeons at our institution to switch to smooth TEs; evaluation is thus required for specific viability and similarity of outcomes of smooth TEs. Our study aims to evaluate perioperative complications in prepectoral placement of smooth versus textured TEs. Methods Our retrospective study evaluated perioperative outcomes of patients who underwent bilateral prepectoral TE placement, with either smooth or textured TE, at an academic institution between 2017 and 2021 performed by 2 reconstructive surgeons. The perioperative period was defined as the interval between expander placement until conversion to flap/implant or removal of TE due to complications. Our primary outcomes included hematoma, seroma, wounds, infection, unspecified redness, total number of complications, and returns to operating room secondary to complications. Secondary outcomes included time to drain removal, total number of expansions, hospital length of stay, length of time until the next breast reconstruction procedure, next breast reconstruction procedure, and number of expansions. Results Two hundred twenty-two patients were evaluated in our study (141 textured, 81 smooth). After propensity matching (71 textured, 71 smooth), our univariate logistic regression showed no significant difference in perioperative complications between smooth and textured expanders (17.1% vs 21.1%; P = 0.396) or complications that required a return to the operating room (10.0% vs 9.2%; P = 0.809). No significant differences were noted for hematoma, seroma, infections, unspecified redness, or wounds between both groups. A significant difference was noted in days to drain out (18.57 ± 8.17 vs 20.13 ± 0.07, P = 0.001) and type of the next breast reconstruction procedure (P < 0.001). Our multivariate regression showed that breast surgeon, hypertension, smoking status, and mastectomy weight were significant for increased risk for complications. Conclusion Our study demonstrates similar rates and effectiveness of smooth versus textured TE when used for prepectoral placement, making smooth TEs a safe and valuable alternative for breast reconstruction because of their decreased risk of anaplastic large-cell lymphoma compared with textured TEs.

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Section: Discussionmentioning

confidence: 99%

A Propensity Score–Matched Comparison of Perioperative Outcomes in Prepectoral Smooth Versus Textured Tissue Expander Breast Reconstruction

et al. 2023

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“…This study reproduced what many others have shown: diabetes, BMI, hypertension, and smoking status are all associated with increased risk of complications. 7,[36][37][38] These comorbidities also led to increased risk of requiring treatment, either as an outpatient or in the operating room.…”

Section: Discussionmentioning

confidence: 99%

“To Ablate or Not to Ablate: The Question if Umbilectomy Decreases Donor Site Complications in DIEP Flap Breast Reconstruction?”

Teotia

2023

Plastic &Amp; Reconstructive Surgery

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Background: Improving outcomes for deep inferior epigastric perforator (DIEP) flap breast reconstruction is an evolving area of interest. The aim of this study was to evaluate the effect of umbilectomy in abdominally based breast reconstruction. Methods: This retrospective study evaluated postoperative outcomes of patients who underwent autologous DIEP flap breast reconstruction at an academic center between January of 2015 and December of 2021 performed by one of two reconstructive surgeons. The primary outcome variable was abdominal donor-site complications. A secondary outcome variable was treatment outcomes for complications. Covariates included demographic information, comorbidities, cancer treatment, and smoking. Results: A total of 408 patients underwent DIEP flap breast reconstruction, with 194 (47.5%) undergoing umbilectomy. Umbilectomy resulted in decreased number of total wounds per patient (0.35 ± 0.795) compared with umbilical preservation (0.75 ± 1.322; P < 0.001), as well as decreased associated risk of any reported wounds (OR, 0.530; P = 0.009). Associations that trended toward significance occurred between umbilectomy and minor wound separation and partial necrosis, with both showing decreased risk. A significant association was noted between umbilectomy and donor-site seroma [χ2(1) = 6.348; P = 0.016], showing an increased risk (OR, 5.761). Conclusions: Umbilectomy should be discussed with patients and considered as a part of DIEP flap breast reconstruction given the reduction in the risk of abdominal donor-site wounds. Although umbilectomy decreases the rate of wounds, it can increase the risk of seroma; therefore, other interventions, such as progressive tension sutures, may be explored to aid in reducing seroma and improving wound healing. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.

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“…This modified MetS has been widely used in related literature, both in orthopaedics and otherwise. 32–37…”

Section: Methodsmentioning

confidence: 99%

“…This modified MetS has been widely used in related literature, both in orthopaedics and otherwise. [32][33][34][35][36][37] To assess each component of MetS individually, patients with a single component (eg, obesity) were compared with a metabolically healthy cohort without the characteristic of interest (eg, nonobese patients, who, by definition, do not have MetS). For patients with MetS, the comparison group consisted of patients without MetS or obesity.…”

Section: Statistical Analysis Of Metsmentioning

confidence: 99%

A component-based analysis of metabolic syndrome's impact on 30-day outcomes after hip fracture: reduced mortality in obese patients

Singh,

Kotzur,

Vivancos-Koopman

et al. 2024

OTA International

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Introduction: Hip fractures are a common injury associated with significant morbidity and mortality. In the United States, there has been a rapid increase in the prevalence of metabolic syndrome (MetS), a condition comprised several common comorbidities, including obesity, diabetes mellitus, and hypertension, that may worsen perioperative outcomes. This article assesses the impact of MetS and its components on outcomes after hip fracture surgery. Methods: Patients who underwent nonelective operative treatment for traumatic hip fractures were identified in the 2015–2020 American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database. Baseline characteristics between groups were compared, and significant differences were included as covariates. Multivariate regression was performed to assess the impact of characteristics of interest on postoperative outcomes. Patients with MetS, or a single one of its constitutive components—hypertension, diabetes, and obesity—were compared with metabolically healthy cohorts. Results: In total 95,338 patients were included. Patients with MetS had increased complications (OR 1.509; P < 0.001), but reduced mortality (OR 0.71; P < 0.001). Obesity alone was also associated with increased complications (OR 1.14; P < 0.001) and reduced mortality (OR 0.736; P < 0.001). Both hypertension and diabetes alone increased complications (P < 0.001) but had no impact on mortality. Patients with MetS did, however, have greater odds of adverse discharge (OR 1.516; P < 0.001), extended hospital stays (OR 1.18; P < 0.001), and reoperation (OR 1.297; P = 0.003), but no significant difference in readmission rate. Conclusion: Patients with MetS had increased complications but decreased mortality. Our component-based analysis showed had obesity had a similar effect: increased complications but lower mortality. These results may help surgeons preoperatively counsel patients with hip fracture about their postoperative risks.

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The Association Between Metabolic Derangement and Wound Complications in Elective Plastic Surgery

Cited by 11 publications

References 47 publications

A Propensity Score–Matched Comparison of Perioperative Outcomes in Prepectoral Smooth Versus Textured Tissue Expander Breast Reconstruction

A Propensity Score–Matched Comparison of Perioperative Outcomes in Prepectoral Smooth Versus Textured Tissue Expander Breast Reconstruction

“To Ablate or Not to Ablate: The Question if Umbilectomy Decreases Donor Site Complications in DIEP Flap Breast Reconstruction?”

A component-based analysis of metabolic syndrome's impact on 30-day outcomes after hip fracture: reduced mortality in obese patients

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