Breast reconstruction in the morbidly obese patient: assessment of 30-day complications using the 2005 to 2010 National Surgical Quality Improvement Program data sets.
BACKGROUND
The authors assess the risk and safety profiles of both implant and autologous breast reconstructions in the morbidly obese population using the National Surgical Quality Improvement Program data sets.


METHODS
The authors reviewed the 2005 to 2010 National Surgical Quality Improvement Program databases, identifying encounters for Current Procedural Terminology codes including either implant-based reconstruction or autologous reconstruction. Patients were classified and compared based on World Health Organization obesity criteria. Complications were divided into three categories: major surgical complications, wound complications, and medical complications.


RESULTS
During the study period, 15,937 breast reconstructions were identified. The incidence of obesity was 27.1 percent, with 4.0 percent defined as class III (morbidly) obese. Morbidly obese patients had significantly higher rates of almost all complications compared with nonobese patients, including major surgical complications (p < 0.001), medical complications (p < 0.001), respiratory complications (p = 0.015), venous thromboembolism (p = 0.001), and wound complications (p < 0.001). These patients also were more likely to require a return to the operating room both for any reason (p < 0.001) and specifically for prosthesis/flap failure (p < 0.001). Morbid obesity was found to be an independent predictor of wound complications (OR, 2.1; p < 0.001), surgical complications (OR, 1.6; p < 0.001), medical complications (OR, 1.6; p = 0.01), and return to the operating room (OR, 1.5; p < 0.001). There was no significant difference in the 30-day surgical complication rates between implant and autologous reconstructions in the morbidly obese (p = 0.23).


CONCLUSIONS
Morbid obesity is associated with a significantly increased risk of perioperative complications that translates into progressive, higher rates of overall morbidity, regardless of reconstructive modality.


METHODS
Risk, II.
Philadelphia, Pa. From the Division of Plastic Surgery, Hospital of the University of Pennsylvania.
John P
JP
Fischer
Emily C
EC
Cleveland
Jonas A
JA
Nelson
Stephen J
SJ
Kovach
Joseph M
JM
Serletti
Liza C
LC
Wu
Suhail
S
Kanchwala
D000328:Adult; D001943:Breast Neoplasms / Q000601:surgery*; D015897:Comorbidity; D016208:Databases, Factual / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D015994:Incidence; D016462:Mammaplasty / Q000592:standards* / Q000706:statistics & numerical data*; D008875:Middle Aged; D064827:Myocutaneous Flap; D009767:Obesity, Morbid / Q000453:epidemiology*; D011183:Postoperative Complications / Q000453:epidemiology* / Q000601:surgery; D058996:Quality Improvement / Q000458:organization & administration; D012086:Reoperation / Q000706:statistics & numerical data; D012307:Risk Factors; D064171:Superficial Back Muscles / Q000637:transplantation; D016896:Treatment Outcome