The Impact of Diabetes Mellitus on Breast Reconstruction Outcomes and Complications: A Systematic Literature Review and Meta-analysis

Mortada, Hatan; Alwadai, Abdulelah Ahmed; Bamakhrama, Basma; Alsinan, Tuqa A; Hanawi, Maha; Alfaryan, Saud Mansour; Obeid, Faisal M.; Arab, Khalid

doi:10.1007/s00266-023-03258-6

Cited by 7 publications

(14 citation statements)

References 57 publications

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“…19 Previous research has found that patients with DM face increased risks of wound complications, infection, and prolonged LOS following breast reconstruction, although these studies did not differentiate between ABR and IBR. [10][11][12][13] In this study, DM was found to be associated with a higher risk of infection in ABR but not in IBR patients. Wound complications, including wound dehiscence and superficial and deep wound complications, showed no significant difference between DM and non-DM patients in ABR or IBR.…”

Section: Discussionmentioning

confidence: 45%

“…Additionally, in line with previous research, this study noted a prolonged LOS in patients with DM undergoing both ABR and IBR, which may be attributed to delayed healing and an increased rate of complications in DM patients. [10][11][12][13] Additionally, this study revealed an association between DM and increased risks of organ system complications, including renal and respiratory dysfunctions, following breast reconstruction. Vascular injury, which is common in DM, can lead to postoperative renal complications due to microvascular injury-related nephropathy.…”

Section: Discussionmentioning

confidence: 65%

“…Numerous studies have explored the impact of DM on breast reconstruction outcomes but with their limitations. [9][10][11][12][13] For example, ABR and IBR are associated with distinct sets of complications, yet previous metaanalyses on DM patients undergoing breast reconstruction did not distinguish between these procedures. 11,12 Similarly, some single-institution studies on breast reconstruction outcomes in DM patients also failed to differentiate between ABR and IBR.…”

Section: Discussionmentioning

confidence: 99%

“…[9][10][11][12][13] For example, ABR and IBR are associated with distinct sets of complications, yet previous metaanalyses on DM patients undergoing breast reconstruction did not distinguish between these procedures. 11,12 Similarly, some single-institution studies on breast reconstruction outcomes in DM patients also failed to differentiate between ABR and IBR. 10,13 Hart et al did differentiate between ABR and IBR and found delayed wound healing in IBR but not in ABR; however, their conclusions were based on a relatively small sample of 1035 patients.…”

Section: Discussionmentioning

confidence: 99%

“…8 Several studies have established a connection between DM and higher rates of surgical complications, such as infection and wound dehiscence, after breast reconstruction. [9][10][11][12][13] However, since ABR and IBR present with different sets of risks, the main limitation of these studies was their failure to differentiate between the reconstruction procedures. [10][11][12][13] For the study that separated ABR and IBR, the generalizability of the conclusion was constrained because of their reliance on single institutional data.…”

Section: Introductionmentioning

confidence: 99%

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In hospital outcomes of autologous and implant‐based breast reconstruction in patients with diabetes mellitus: A population‐based study of 2015–2020 national inpatient sample

Li,

Ranganath

2024

World j. surg.

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BackgroundBreast reconstruction encompasses autologous (ABR) and implant‐based breast reconstruction (IBR) each with its own sets of potential complications. Diabetes mellitus (DM) is associated with breast reconstruction complications, although most of the studies did not differentiate between the reconstruction procedures. This study conducted a population‐based study examining impact of DM on inhospital outcomes in ABR and IBR.MethodsPatients underwent ABR or IBR were identified in National Inpatient Sample from Q4 2015 to 2020. A 1:2 propensity score matching was used to address differences in demographics, hospital characteristics, primary payer status, comorbidities, and reconstruction staging between DM and non‐DM patients. In hospital outcomes were assessed separately in ABR and IBR.ResultsThere were 997 (7.68%) DM and 11,987 (92.32%) non‐DM patients in ABR. Meanwhile, 1325 (7.38%) DM and 16,638 (92.62%) non‐DM patients underwent IBR. DM cohorts in ABR and IBR were matched to 1930 and 2558 non‐DM patients, respectively. After matching, DM patients in both ABR and IBR had higher risks of renal complications (ABR, 3.73% vs. 1.76%, p < 0.01; IBR, 1.83% vs. 0.78%, p = 0.01) and longer length of stay (ABR, p = 0.01; IBR, p = 0.04). In ABR, DM patients had higher respiratory complications (2.82% vs. 1.19%, p < 0.01), excessive scarring (2.72% vs. 1.55%, p = 0.03), and infection (2.42% vs. 1.14%, p = 0.01), while in IBR, DM patients had higher hemorrhage/hematoma (5.40% vs. 3.40%, p < 0.01) and transfer out (1.52% vs. 0.78%, p = 0.04).ConclusionDM was associated with distinct sets of inhospital complications in ABR and IBR, which can be valuable for preoperative risk stratification and informing clinical decision‐making for DM patients.

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