title: Risk analysis of early implant loss after immediate breast reconstruction: a review of 14,585 patients.
abstract: BACKGROUND
  Early prosthesis loss is an infrequent but serious complication after breast reconstruction. We assessed perioperative risk factors associated with early device loss after immediate breast reconstruction (IBR) using the ACS-NSQIP datasets.
  
  
  METHODS
  We reviewed the 2005 to 2011 ACS-NSQIP databases identifying encounters for CPT codes 19357 and 19340. Patients were identified as experiencing a "loss of graft/prosthetic" based on a standard dataset variable. Patients who experienced a device loss were compared with those who did not with respect to perioperative characteristics.
  
  
  RESULTS
  We identified 14,585 patients with an average age of 50.9 ± 10.6 years. A multivariate regression analysis determined that age (>55 years) (odds ratio [OR] 1.66, p = 0.013) (risk score = 1), class II obesity (OR 3.17, p < 0.001) (risk score = 3), class III obesity (OR 2.41, p = 0.014) (risk score = 3), active smoking (OR 2.95, p < 0.001) (risk score = 3), bilateral reconstruction (OR 1.67, p = 0.007) (risk score = 1), and direct-to-implant (DTI) reconstruction (OR 1.69, p = 0.024) (risk score = 1) were associated with early device loss. Odds ratios were used to assign weighted risk scores to each patient, and risk categories were broken into low risk (0 to 1, n = 9,349), intermediate risk (2 to 5, n = 5,001), and high risk (≥ 6, n = 233) groups. The risk of device loss was significantly higher with increased risk score (0.39% vs 1.48% vs 3.86%, p < 0.001).
  
  
  CONCLUSIONS
  Early device loss following IBR is a complex multifactorial process related to identifiable preoperative risk factors. This study demonstrated that age, obesity, smoking, bilateral procedures, and DTI reconstructions are associated with increased risk of implant loss.
authors: Divisions of Plastic Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA. Electronic address: John.Fischer2@uphs.upenn.edu.
authors: John P
authors: JP
authors: Fischer
authors: Ari M
authors: AM
authors: Wes
authors: Charles T
authors: CT
authors: Tuggle
authors: Joseph M
authors: JM
authors: Serletti
authors: Liza C
authors: LC
authors: Wu
mesh_terms: D000328:Adult; D019928:Breast Implantation / Q000295:instrumentation*; D018427:Breast Implants; D016208:Databases, Factual; D003661:Decision Support Techniques; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016015:Logistic Models; D008408:Mastectomy; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D017063:Outcome Assessment, Health Care; D011475:Prosthesis Failure / Q000209:etiology*; D018570:Risk Assessment; D012307:Risk Factors
keywords: BMI; CPT; Current Procedural Terminology; DTI; IBR; OR; TE; body mass index; direct-to-implant; immediate breast reconstruction; odds ratio; tissue expander