The Effect of Timing on Breast Reconstruction Outcomes in Diabetic Women

• Published in: Plastic and reconstructive surgery. Global open Vol. 4; no. 10; p. e1090
• Main Authors: Major, Melanie, Devulapalli, Chris, Bello, Ricardo J, Baltodano, Pablo A, Reinhardt, Myrna Eliann, Manahan, Michele A, Cooney, Carisa M, Rosson, Gedge D
• Format: Journal Article
• Language: English
• Published: United States Copyright The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the American Society of Plastic Surgeons. All rights reserved 01.10.2016; Wolters Kluwer Health
• Subjects: Original
• ISSN: 2169-7574; 2169-7574
• DOI: 10.1097/GOX.0000000000001090

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 reconstruction958 (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 women59 (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.