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The Effect of Timing on Breast Reconstruction Outcomes in Diabetic Women
BACKGROUND: This study examines the effect of timing (immediate vs delayed) on postoperative morbidity in diabetic women undergoing breast reconstruction after mastectomy. METHODS: We reviewed the National Surgical Quality Improvement Program (NSQIP) databases from 2005 to 2012 for all diabetic wome...
Autores principales: | , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Wolters Kluwer Health
2016
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5096538/ https://www.ncbi.nlm.nih.gov/pubmed/27826483 http://dx.doi.org/10.1097/GOX.0000000000001090 |
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author | Major, Melanie Devulapalli, Chris Bello, Ricardo J. Baltodano, Pablo A. Reinhardt, Myrna Eliann Manahan, Michele A. Cooney, Carisa M. Rosson, Gedge D. |
author_facet | Major, Melanie Devulapalli, Chris Bello, Ricardo J. Baltodano, Pablo A. Reinhardt, Myrna Eliann Manahan, Michele A. Cooney, Carisa M. Rosson, Gedge D. |
author_sort | Major, Melanie |
collection | PubMed |
description | BACKGROUND: This study examines the effect of timing (immediate vs delayed) on postoperative morbidity in diabetic women undergoing breast reconstruction after mastectomy. METHODS: We reviewed the National Surgical Quality Improvement Program (NSQIP) databases from 2005 to 2012 for all diabetic women undergoing breast reconstruction. Multivariable logistic regression was used to estimate the risk of 30-day overall complications in the immediate versus delayed cohorts. Additionally, we retrospectively reviewed outcomes for all Johns Hopkins Hospital diabetic patients undergoing breast reconstruction from 2005 to 2014. RESULTS: In the NSQIP, 1,408 diabetic women underwent breast reconstruction: 958 (68%) immediate and 450 (32%) delayed. In the immediate group, 10.75% of patients developed a 30-day overall complication, compared with 7.78% of patients in the delayed group. On multivariable analysis, the odds of developing 30-day overall complications were significantly higher (adjusted odds ratio = 1.68; P = 0.033) for the immediate compared with the delayed cohort. In the Johns Hopkins Hospital cohort, 114 reconstructions were performed in 52 diabetic women: 59 (51.8%) immediate and 55 (47.2%) delayed. On long-term follow-up (median = 16.5 months), 41.0% of immediate reconstructions developed a surgical complication compared with 27.8% of delayed reconstructions. Deep infections (P = 0.026), seroma formation (P = 0.003), reconstruction failure (P = 0.001), and reoperation rates (P = 0.001) were significantly increased in the immediate cohort. CONCLUSIONS: Among diabetics seeking breast reconstruction, delaying the reconstructive surgery from the mastectomy is associated with decreased postoperative morbidity. It also appears that the 30-day postoperative time point available in the NSQIP does not fully reflect the magnitude of the long-term complications these diabetic patients will develop. |
format | Online Article Text |
id | pubmed-5096538 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2016 |
publisher | Wolters Kluwer Health |
record_format | MEDLINE/PubMed |
spelling | pubmed-50965382016-11-08 The Effect of Timing on Breast Reconstruction Outcomes in Diabetic Women Major, Melanie Devulapalli, Chris Bello, Ricardo J. Baltodano, Pablo A. Reinhardt, Myrna Eliann Manahan, Michele A. Cooney, Carisa M. Rosson, Gedge D. Plast Reconstr Surg Glob Open Original Article BACKGROUND: This study examines the effect of timing (immediate vs delayed) on postoperative morbidity in diabetic women undergoing breast reconstruction after mastectomy. METHODS: We reviewed the National Surgical Quality Improvement Program (NSQIP) databases from 2005 to 2012 for all diabetic women undergoing breast reconstruction. Multivariable logistic regression was used to estimate the risk of 30-day overall complications in the immediate versus delayed cohorts. Additionally, we retrospectively reviewed outcomes for all Johns Hopkins Hospital diabetic patients undergoing breast reconstruction from 2005 to 2014. RESULTS: In the NSQIP, 1,408 diabetic women underwent breast reconstruction: 958 (68%) immediate and 450 (32%) delayed. In the immediate group, 10.75% of patients developed a 30-day overall complication, compared with 7.78% of patients in the delayed group. On multivariable analysis, the odds of developing 30-day overall complications were significantly higher (adjusted odds ratio = 1.68; P = 0.033) for the immediate compared with the delayed cohort. In the Johns Hopkins Hospital cohort, 114 reconstructions were performed in 52 diabetic women: 59 (51.8%) immediate and 55 (47.2%) delayed. On long-term follow-up (median = 16.5 months), 41.0% of immediate reconstructions developed a surgical complication compared with 27.8% of delayed reconstructions. Deep infections (P = 0.026), seroma formation (P = 0.003), reconstruction failure (P = 0.001), and reoperation rates (P = 0.001) were significantly increased in the immediate cohort. CONCLUSIONS: Among diabetics seeking breast reconstruction, delaying the reconstructive surgery from the mastectomy is associated with decreased postoperative morbidity. It also appears that the 30-day postoperative time point available in the NSQIP does not fully reflect the magnitude of the long-term complications these diabetic patients will develop. Wolters Kluwer Health 2016-10-25 /pmc/articles/PMC5096538/ /pubmed/27826483 http://dx.doi.org/10.1097/GOX.0000000000001090 Text en Copyright © 2016 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The American Society of Plastic Surgeons. All rights reserved. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND) (http://creativecommons.org/licenses/by-nc-nd/4.0/) , where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially. |
spellingShingle | Original Article Major, Melanie Devulapalli, Chris Bello, Ricardo J. Baltodano, Pablo A. Reinhardt, Myrna Eliann Manahan, Michele A. Cooney, Carisa M. Rosson, Gedge D. The Effect of Timing on Breast Reconstruction Outcomes in Diabetic Women |
title | The Effect of Timing on Breast Reconstruction Outcomes in Diabetic Women |
title_full | The Effect of Timing on Breast Reconstruction Outcomes in Diabetic Women |
title_fullStr | The Effect of Timing on Breast Reconstruction Outcomes in Diabetic Women |
title_full_unstemmed | The Effect of Timing on Breast Reconstruction Outcomes in Diabetic Women |
title_short | The Effect of Timing on Breast Reconstruction Outcomes in Diabetic Women |
title_sort | effect of timing on breast reconstruction outcomes in diabetic women |
topic | Original Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5096538/ https://www.ncbi.nlm.nih.gov/pubmed/27826483 http://dx.doi.org/10.1097/GOX.0000000000001090 |
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