Obesity and early complications following reduction mammaplasty: An analysis of 4545 patients from the 2005–2011 NSQIP datasets

Nelson, Jonas A.; Fischer, John P.; Chung, Cyndi U.; West, Ari; Tuggle, Charles T.; Serletti, Joseph M.; Kovach, Stephen J.

doi:10.3109/2000656x.2014.886582

Cited by 53 publications

(48 citation statements)

References 24 publications

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“…There were three prospective studies while the others were retrospective ones. Mean postoperative follow-up time was noted in nine studies [6, 11, 15, 21–26] and occurred from 1 to 32.9 months after surgery. Five studies [5, 17–19, 27] did not report follow-up time, and the last two studies [14, 20] only reported a range.…”

Section: Resultsmentioning

confidence: 99%

Risk Factors for Complications after Reduction Mammoplasty: A Meta-Analysis

et al. 2016

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BackgroundReduction mammoplasty (RM) is a proven method of treating macromastia, but the risk factors for postoperative complications have not been clearly identified. Through this meta-analysis, the authors aimed to identify the risk factors of RM complications.MethodsAn extensive search of the literature describing complications after RM was performed using the PubMed Central, Embase, and Cochrane databases. The following risk factors were extracted: age, body mass index (BMI), tissue resection weight per breast (TRW), smoking and radiation therapy. Odds ratios (OR) were pooled with 95% confidence intervals (CI) to evaluate the relationship between these risk factors and complications after RM.ResultsA total of 16 unique studies including 10 593 patients were included in the final analysis. It showed that there was a significant difference in complications in BMI ≥30 kg/m2 (OR 0.73; 95% CI: 0.61–0.89, p = 0.001) and smoking (OR 1.56; 95% CI: 0.98–2.49, p = 0.06). Infection in those with BMI ≥30 kg/m2 showed a significant difference (OR 0.68; 95% CI: 0.52–0.89, p = 0.004), as well as wound dehiscence in smokers (OR 2.73; 95% CI: 1.60–4.67, p = 0.0002) and infection in irradiated breasts (OR 20.38; 95% CI: 3.42–121.35, p = 0.0009). However, there was no significant difference in age ≥50 years (OR 0.96; 95% CI: 0.71–1.29, p = 0.78), combined TRW ≥1000 g (OR 1.04; 95% CI: 0.43–2.50, p = 0.93).ConclusionsBMI ≥30 kg/m2 and smoking increase the risk of complications. Persons who are obese or irradiated are more likely to develop infections, and smokers experienced a higher incidence of wound dehiscence than did nonsmokers. However, patients aged ≥50 years and TRW ≥1000 g are not associated with complications from RM.

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Section: Resultsmentioning

confidence: 99%

Risk Factors for Complications after Reduction Mammoplasty: A Meta-Analysis

et al. 2016

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“…[14,15,17] However, contradictory findings exist in the literature as well, supporting obesity as a risk factor. [6,[9][10][11][12][13] Chun et al [13] identified a threshold of BMI 35.6 at which postoperative complications were increased two-fold, the most common complication being infection. The pioneering study using NSQIP data to analyze BMI and breast reduction complications by Nelson et al [6] included 4,545 patients between 2005 and 2011.…”

Section: Discussionmentioning

confidence: 99%

“…[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.…”

Section: Discussionmentioning

confidence: 99%

“…[4,5] The incidence of postoperative complications in reduction mammaplasty is relatively low, approximately 6%. [6] Problems range from minor wound complications and infections to significant bleeding and thromboembolic events. Thorough preoperative assessment is imperative to patient safety and avoiding poor surgical outcomes.…”

Section: Introductionmentioning

confidence: 99%

“…Some studies associate obesity with increased postoperative complications, [9][10][11][12][13] whereas others find no statistically significant correlation. [14][15][16][17] In 2014, Nelson et al [6] studied obesity and reduction mammaplasty using the 2005-2011 American College of Surgeons -National Surgical Quality Improvement Program (ACS-NSQIP) datasets. NSQIP is a nationally-validated, risk-adjusted surgical outcomes database to measure and improve the quality of surgical care.…”

Section: Introductionmentioning

confidence: 99%

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

Goggin¹,

Wong²,

Pruszynski³

et al. 2016

PAR

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Aim: Reduction mammaplasty is a commonly performed procedure for the treatment of symptomatic macromastia and is increasingly desired by the obese population. With the increasing prevalence obesity in the population, it is imperative to understand its effect on postoperative outcomes. The purpose of this study is to evaluate obesity as an independent risk factor for postoperative complications in breast reduction surgery using 1:1 patient matching through propensity scores between obese patients and nonobese controls. Methods: Between 2005 and 2013, the National Surgical Quality Improvement Program dataset identified a total of 6,016 patients as having undergone primary reduction mammaplasty with 30-day postoperative follow-up. Patients were divided into obese [body mass index (BMI) of 30 or more] vs. not obese (BMI below 30). Patients were initially analyzed using standard multivariable analysis. Using propensity scores obtained from a logistic regression model, patients were subsequently matched 1:1 according to preoperative and operative variables to truly isolate the effect of obesity on surgical outcomes. Outcomes were compared between the matched cohorts using McNemar's test and the Wilcoxon signed rank test. Results: In unmatched multivariable analysis, rates of overall complications (7.2% vs. 5.3%, P = 0.0024), wound complications (5.5% vs. 3.6%, P = 0.0004), superficial surgical site infection (4.1% vs. 2.8%, P = 0.0050), and wound dehiscence (0.3% vs. 1.1%, P = 0.0005) were found to be statistically different between obese vs. non-obese, respectively. However, when comparing 1:1 matched obese and non-obese patients, only wound complications (4.6% vs. 3.1%, P = 0.0334) were significantly increased in the obese cohort. Conclusion: Using the most robust statistical tools available, obesity was

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The impact of body mass index on oncoplastic breast surgery: A multicenter analysis

De La Cruz Ku,

Camarlinghi,

Mallouh

et al. 2023

Journal of Surgical Oncology

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BackgroundObesity has nearly tripled in the last 50 years. During the last decades, oncoplastic breast surgery has become an important choice in the surgical treatment of breast cancer. An association exists between higher body mass index (BMI) and wound complications for major operations, but there is scarce literature on oncoplastic surgery. Hence, our aim was to compare the complication rates among patients who underwent oncoplastic surgery, stratified by BMI.MethodsPatient data were analyzed from the National Surgical Quality Improvement Program database (NSQIP) for oncoplastic breast procedures (2005–2020). Patients were stratified according to World Health Organization obesity classifications. Multivariate logistic regression was performed to assess risk factors for complications (overall, operative, and wound‐related).ResultsFrom a total of 6887 patients who underwent oncoplastic surgery, 4229 patients were nonobese, 1380 had Class 1 obesity (BMI: 30 to <35 kg/m2), 737 Class 2 obesity (BMI: 35 to <40 kg/m2), and 541 Class 3 obesity (BMI: ≥ 40 kg/m2). Greater operative time was found according to higher BMI (p < 0.001). Multivariate analysis adjusted for baseline characteristics showed that patients with obesity Class 2 (odds ratio [OR] = 1.51, 95% confidence interval [CI]: 1.03–2.23, p = 0.037) and 3 (OR = 1.87, 95% CI 1.24–2.83, p = 0.003) had increased risk of overall and wound complications compared with Nonobese patients. Comparing obese with nonobese patients, there were no differences in rates of deep SSI, organ/space SSI, pneumonia, reintubation, pulmonary embolism, deep vein thrombosis, urinary tract infection, stroke, bleeding, postoperative sepsis, length of stay, and readmission.ConclusionsOncoplastic surgery is a safe procedure for most patients. However, caution should be exercised when performing oncoplastic surgery for patients with Class 2 or 3 obesity (BMI ≥ 35 kg/m2), given there was a higher rate of overall and wound‐specific complications, compared with patients who were not obese or had Class 1 obesity.

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Obesity and early complications following reduction mammaplasty: An analysis of 4545 patients from the 2005–2011 NSQIP datasets

Cited by 53 publications

References 24 publications

Risk Factors for Complications after Reduction Mammoplasty: A Meta-Analysis

Risk Factors for Complications after Reduction Mammoplasty: A Meta-Analysis

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

The impact of body mass index on oncoplastic breast surgery: A multicenter analysis

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