The effect of sarcopenia on perioperative complications in abdominally based free‐flap breast reconstruction

Abstract

Purpose: The identification of patient-specific risk factors, which predict morbidity following abdominally based microvascular breast reconstruction is difficult. Sarcopenia is a proxy for patient frailty and is an independent predictor of complications in a myriad of surgical disciplines. We predict that sarcopenic patients will be at higher risk for surgical complications following abdominally based microvascular breast reconstruction. Methods: A retrospective study of all patients who underwent delayed abdominally based autologous breast reconstruction following postmastectomy radiation therapy from 2007 to 2013 at a single institution was conducted. Univariate and multiple logistic regression models were used to assess the effect of sarcopenia on postoperative outcomes. Results: Two hundred and eight patients met the inclusion criteria, of which 30 met criteria for sarcopenia (14.1%). There were no significant differences in demographics between groups. There were no significant differences in minor (36.7% vs 44.4%; P = .43) or major (16.7% vs 25.3%; P = .36) complications between groups as well as hospital length of stay. Multivariable logistic regression demonstrated that a staged reconstruction with the use of a tissue expander was the only consistent variable, which predicted major complications (OR, 2.24; 95% CI, 1.18-4.64; P = .015). Conclusions: Sarcopenia does not predispose to minor or major surgical complications in patients who undergo abdominally based microsurgical breast reconstruction.

The effect of sarcopenic obesity and muscle quality on complications after DIEP-flap breast reconstruction

“…A study on morbidity after rectal cancer surgery found similar results as our study with higher incidence of complications CD grade ≥ III among patients with sarcopenic obesity (OR adjusted = 3.77, 95%CI = 1.1; 12.7) [ 11 ]. Some studies on SMD used different absolute cut-off values for SMD and are thereby difficult to compare to our results [ 29 , 30 , 31 , 32 ]. In one study assessing SMD in patients treated for rectal cancer, outcome was also compared for those with SMD below and above the median, similar to the current study, which was 40HU for our study group.…”

“…In one of these studies an increased complication incidence, hospital stay and ICU length of stay was found in women with sarcopenia versus women without sarcopenia [ 29 ]. In the other study, no difference in complication incidence was found related to sarcopenia [ 30 ]. The relation between sarcopenic obesity, decreased SMD and increased risk of postoperative complications has been recognized earlier among patients undergoing other types of major surgery.…”

“…This is the first study assessing sarcopenic obesity (BMI ≥25 & SMI<39) and SMD in women undergoing DIEP-flap BR and one of the very few looking at body composition parameters in women undergoing BR. There is some research on the effect of sarcopenia defined as SMI<38.5, and complications after DIEP-flap BR which found contradictory results [ 29 , 30 ]. In one of these studies an increased complication incidence, hospital stay and ICU length of stay was found in women with sarcopenia versus women without sarcopenia [ 29 ].…”

Response to comment on “the effect of sarcopenia on perioperative complications in abdominally based free‐flap breast reconstruction

“…We have read with great interest the comments of Drs. Binay Safer and Safer regarding our recently published article, “The effect of sarcopenia on perioperative complications in abdominally based free‐flap breast reconstruction.” 1 We thank the authors for their comments and are very grateful to them for giving us the opportunity to further discuss the methodology of our study.…”

Comment on “The effect of sarcopenia on perioperative complications in abdominally based free‐flap breast reconstruction”

“…The authors concluded that sarcopenia, which can reliably be discerned by routine, preoperative abdominal computed tomography (CT) scans, was not related to minor or major surgical complications in patients who undergo abdominally based microvascular breast reconstruction. 1 Sarcopenia has been extensively studied in patients undergoing oncologic procedures, however diagnostic approach in these trials has ongoing discussions. [2][3][4] So, we would like to address some methodological points in this manuscript.…”