title: Peri-operative risk factors associated with early tissue expander (TE) loss following immediate breast reconstruction (IBR): a review of 9305 patients from the 2005-2010 ACS-NSQIP datasets.
abstract: BACKGROUND
  Early loss of an implant is a serious complication following breast reconstruction. We assess perioperative risk factors associated with tissue expander (TE) loss following immediate breast reconstruction (IBR) using the ACS-NSQIP datasets.
  
  
  METHODS
  We reviewed the 2005-2010 ACS-NSQIP databases identifying encounters for CPT codes for IBR using TE (19357). Patients were identified as experiencing a "loss of graft/prosthetic" based on a defined dataset variable. Patients who experienced a TE loss were compared to those who did not with respect to peri-operative characteristics.
  
  
  RESULTS
  9305 patients were identified who were on average 51.0 ± 10.5 years. Average length of stay was 1.7 ± 1.7 days. Patients experiencing early TE loss tended to have higher BMI (P < 0.0001) and ages (P < 0.001), more often be obese (P < 0.001), be active smokers (P < 0.001), and have hypertension (P = 0.001). Patients experiencing TE loss also more frequently had longer operative times (P = 0.0002), total length of stay (P = 0.004), superficial surgical site infections (P = 0.004), and deep surgical infections (P < 0.0001). A multivariate regression analysis determined age (>55 years) (OR = 2.0, P = 0.004), obesity (BMI ≥ 30 kg/m(2)) (OR = 1.7, P = 0.03), active smoking (OR = 4.0, P < 0.001), prolonged operative time (>1 SD above average) (OR = 2.2, P = 0.002), superficial wound infection (OR = 4.0, P = 0.002), and deep wound infection (OR = 9.1, P < 0.001) were associated with early TE loss.
  
  
  CONCLUSIONS
  Early TE loss is a complex multifactorial process likely related to identifiable preoperative, modifiable risk factors and postoperative complications. This analysis highlights previous work demonstrating of the added risk of age, obesity, and active smoking.
authors.affiliation: Division of Plastic Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: John P
authors.initials: JP
authors.lastname: Fischer
authors.forename: Jonas A
authors.initials: JA
authors.lastname: Nelson
authors.forename: Joseph M
authors.initials: JM
authors.lastname: Serletti
authors.forename: Liza C
authors.initials: LC
authors.lastname: Wu
mesh_terms: D000328:Adult; D000367:Age Factors; D015992:Body Mass Index; D018427:Breast Implants / Q000009:adverse effects*; D005260:Female; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D007902:Length of Stay; D016462:Mammaplasty / Q000009:adverse effects*; D008408:Mastectomy / Q000009:adverse effects; D008875:Middle Aged; D009765:Obesity / Q000453:epidemiology; D061646:Operative Time; D059035:Perioperative Period; D011475:Prosthesis Failure; D018570:Risk Assessment; D012307:Risk Factors; D012907:Smoking / Q000453:epidemiology; D013530:Surgical Wound Infection / Q000453:epidemiology; D015626:Tissue Expansion / Q000009:adverse effects*
keywords: Complication; Loss; NSQIP; Outcomes; Risk analysis; Tissue expander