title: Higher rate of breast surgery complications in patients with metastatic breast cancer: an analysis of the NSQIP database.
abstract: BACKGROUND
  Four percent of breast cancer patients present with metastatic disease. To date, no one has examined whether these patients are at higher risk of postoperative complications. The objective of this study was to determine morbidity and mortality associated with breast surgery in the metastatic setting.
  
  
  METHODS
  We analyzed the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database, including breast cancer patients undergoing primary breast surgery from 2005 to 2012. Patients with bilateral surgery or severe comorbidities were excluded. Multivariable logistic regression was performed to determine the independent effect of metastatic breast cancer on postoperative morbidity and mortality.
  
  
  RESULTS
  We identified 68,316 patients who underwent breast surgery for invasive breast cancer; 1,031 (1.5 %) had metastatic disease. The 30-day unadjusted morbidity was significantly higher in the metastatic cohort (7.5 vs. 3.7 %; p < 0.001), as was the all-cause 30-day mortality (1.8 vs. 0.06 %; p < 0.001). The metastatic cohort was more likely to experience an: infectious, respiratory, thromboembolic, cardiac, or bleeding complication than non-metastatic patients. However, preoperative chemo- and radiation therapy did not contribute to an overall increased complication rate. The adjusted odds ratio for postoperative complications in the setting of metastatic disease was 1.6 (95 % confidence limit 1.2-2.1).
  
  
  CONCLUSIONS
  This is the first study documenting the morbidity and mortality associated with breast surgery in metastatic breast cancer. The 30-day morbidity and mortality in this population is higher than in patients with stage I-III disease. Although the complication rate is increased, operating on the primary in metastatic breast cancer is relatively safe.
authors: Department of Surgery, University of Toronto, Toronto, ON, Canada, erin.cordeiro@gmail.com.
authors: Erin
authors: E
authors: Cordeiro
authors: Timothy D
authors: TD
authors: Jackson
authors: Ahmad
authors: A
authors: Elnahas
authors: Tulin
authors: T
authors: Cil
mesh_terms: D001943:Breast Neoplasms / Q000401:mortality* / Q000556:secondary / Q000601:surgery*; D015331:Cohort Studies; D015897:Comorbidity; D016208:Databases, Factual; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008408:Mastectomy / Q000009:adverse effects*; D008875:Middle Aged; D009367:Neoplasm Staging; D011183:Postoperative Complications / Q000175:diagnosis* / Q000209:etiology / Q000401:mortality; D011379:Prognosis; D012307:Risk Factors; D015996:Survival Rate