title: Complications following reduction mammaplasty: a review of 3538 cases from the 2005-2010 NSQIP data sets.
abstract: BACKGROUND
  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.
  
  
  OBJECTIVE
  The authors investigate predictors of postoperative complications following reduction mammaplasty using the National Surgery Quality Improvement Program (NSQIP) data sets.
  
  
  METHODS
  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.
  
  
  RESULTS
  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).
  
  
  CONCLUSIONS
  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.
authors: Division of Plastic Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
authors: John P
authors: JP
authors: Fischer
authors: Emily C
authors: EC
authors: Cleveland
authors: Eric K
authors: EK
authors: Shang
authors: Jonas A
authors: JA
authors: Nelson
authors: Joseph M
authors: JM
authors: Serletti
mesh_terms: D000328:Adult; D001940:Breast / Q000002:abnormalities* / Q000601:surgery; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D006984:Hypertrophy / Q000601:surgery*; D015994:Incidence; D016015:Logistic Models; D016462:Mammaplasty / Q000009:adverse effects*; D008875:Middle Aged; D009767:Obesity, Morbid / Q000453:epidemiology; D016017:Odds Ratio; D011183:Postoperative Complications / Q000453:epidemiology* / Q000601:surgery; D012086:Reoperation; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects / Q000453:epidemiology; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
keywords: NSQIP; breast reduction; complications; outcomes