Complications following reduction mammaplasty: a review of 3538 cases from the 2005-2010 NSQIP data sets

• Published in: Aesthetic surgery journal Vol. 34; no. 1; p. 66
• Main Authors: Fischer, John P, Cleveland, Emily C, Shang, Eric K, Nelson, Jonas A, Serletti, Joseph M
• Format: Journal Article
• Language: English
• Published: England 01.01.2014
• Subjects: Adult; Breast - abnormalities; Breast - surgery; Chi-Square Distribution; Female; Humans; Hypertrophy - surgery; Incidence; Logistic Models; Mammaplasty - adverse effects; Middle Aged; Obesity, Morbid - epidemiology; Odds Ratio; Postoperative Complications - epidemiology; Postoperative Complications - surgery; Reoperation; Risk Factors; Smoking - adverse effects; Smoking - epidemiology; Treatment Outcome; United States - epidemiology; United States; NSQIP; complications; outcomes; breast reduction
• ISSN: 1527-330X
• DOI: 10.1177/1090820X13515676

Reduction mammaplasty is an established and effective technique to treat symptomatic macromastia. Variable rates of complications have been reported, and there is a continued need for better outcome assessment studies. The authors investigate predictors of postoperative complications following reduction mammaplasty using the National Surgery Quality Improvement Program (NSQIP) data sets. The 2005-2010 American College of Surgeons NSQIP databases were reviewed to identify primary encounters for reduction mammaplasty using Current Procedural Terminology code 19318. Two complication types were recorded: major complications (deep infection and return to operating room) and any complication (all surgical complications). Preoperative patient factors and comorbidities, as well as intraoperative variables, were assessed. A multivariate regression analysis was used to identify independent predictors of complications. A total of 3538 patients were identified with an average age of 43 years and body mass index of 31.6 kg/m(2). Most patients underwent outpatient surgery (80.5%) with an average operative time of 180 minutes. The incidence of overall surgical complications was 5.1%. The following factors were independently associated with any surgical complications: morbid obesity (odds ratio [OR], 2.1; P < .001), active smoking (OR, 1.7; P < .001), history of dyspnea (OR, 2.0; P < .001), and resident participation (OR, 1.8; P = .01). The incidence of major surgical complications was 2.1%. Factors associated with major complications included active smoking (OR, 2.7; P < .001), dyspnea (OR, 2.6; P < .001), resident participation (OR, 2.1; P < .001), and inpatient surgery (OR, 1.8; P = .01). This study demonstrates overall incidence of complications in 1 in 20 patients and a 1 in 50 incidence of a major surgical complication. Noteworthy findings include the identification of morbid obesity as a significant predictor of overall morbidity and active smoking as a strong predictor of major surgical morbidity. These data can assist surgeons in preoperative counseling and enhance perioperative decision making.