Association of Preoperative Sarcopenia with Adverse Outcomes of Breast Reconstruction Using Deep Inferior Epigastric Artery Perforator Flap

Kim, Sungjin; Lee, Kyeong‐Tae; Jeon, Byung-Joon; Pyon, Jai Kyong; Mun, Goo‐Hyun

doi:10.1245/s10434-022-11362-1

Cited by 5 publications

(2 citation statements)

References 20 publications

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“…This finding related to sarcopenia is supported by several studies in the literature, though it does stand in contrast to those of others. Kim et al 22 described a series of patients who underwent FFBR, with preoperative sarcopenia associated with significantly higher rates of complication and BMI not associated with complications, though they did not include the mFI. This was also supported by the findings of Pittelkow et al, who found similar results in 103 patients, again not including the mFI.…”

Section: Discussionmentioning

confidence: 99%

Sarcopenia Best Predicts Complications in Free Flap Breast Reconstruction

Jain

Bingham

Luvisa

et al. 2023

Plastic and Reconstructive Surgery - Global Open

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Background: Breast reconstruction remains a major component of the plastic surgeon’s repertoire, especially free-flap breast reconstruction (FFBR), though this is a high-risk surgery in which patient selection is paramount. Preoperative predictors of complication remain mixed in their utility. We sought to determine whether the sarcopenia score, a validated measure of physiologic health, outperforms the body mass index (BMI) and modified frailty index (mFI) in terms of predicting outcomes. Methods: All patients with at least 6-months follow-up and imaging of the abdomen who underwent FFBR from 2013 to 2022 were included in this study. Appropriate preoperative and postoperative data were included, and sarcopenia scores were extracted from imaging. Complications were defined as any unexpected outcome that required a return to the operating room or readmission. Statistical analysis and regression were performed. Results: In total, 299 patients were included. Patients were split into groups, based on sarcopenia scores. Patients with lower sarcopenia had significantly more complications than those with higher scores. BMI and mFI both did not correlate with complication rates. Sarcopenia was the only independent predictor of complication severity when other factors were controlled for in a multivariate regression model. Conclusions: Sarcopenia correlates with the presence of severe complications in patients who undergo FFBR in a stronger fashion to BMI and the mFI. Thus, sarcopenia should be considered in the preoperative evaluation in patients undergoing FFBR.

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Section: Discussionmentioning

confidence: 99%

Sarcopenia Best Predicts Complications in Free Flap Breast Reconstruction

Jain

Bingham

Luvisa

et al. 2023

Plastic and Reconstructive Surgery - Global Open

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“…8,9 The effect of sarcopenia on postoperative complications following abdominally based breast reconstruction has also demonstrated inconsistent findings. [10][11][12] Therefore, research examining the interplay between CTA characteristics and patient risk factors in complications following DIEP breast reconstruction requires continued investigation.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of Morphometric Measurements on Preoperative CT Angiograms to Determine Risk of Abdominal Donor Site Complications—A Retrospective Review of 174 Patients

Shaffrey

Seitz

et al. 2022

Plast Surg (Oakv)

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Introduction: Autologous breast reconstruction remains a popular surgical option following mastectomy; however, it is not without complications. Preoperative CT angiograms (CTAs) are often obtained for surgical planning, and morphometric data such as fat and muscle distribution can be measured. This study aimed to assess if CTA morphometric data predicts abdominal donor site complications in patients undergoing abdominally based autologous breast reconstruction. Methods: A retrospective cohort study was performed for patients who underwent abdominally based autologous breast reconstruction from 2013 to 2018. Along with population and operative characteristics, preoperative morphometric variables were assessed for the following: subcutaneous adipose tissue, visceral adipose tissue, skeletal muscle area and index, rectus and psoas cross-sectional area, and bone density. Statistical comparison to abdominal donor site complications was performed using logistic regression analysis for every 100-unit change. Results: A total of 174 patients were included in this study. Visceral adipose tissue was significantly associated with the development of infection ( P = .005), epidermolysis ( P = .031), and seroma ( P = .04). Subcutaneous adipose tissue, skeletal muscle index, cross-sectional muscle area, and bone density were not associated with abdominal donor site complications. Obesity ( P = .024), history of smoking ( P = .049), and the number of perforators harvested ( P = .035) significantly increased the likelihood of delayed abdominal healing. Conclusions: This study demonstrates that increased visceral adipose tissue, as measured by CTA, is significantly associated with an increased risk of abdominal donor site complications. CTA morphometric data and identifying high-risk patient characteristics can help guide preoperative counseling and better inform surgical risks.

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