title: Wound healing complications after autologous breast reconstruction: a model to predict risk.
abstract: BACKGROUND
  Delayed wound healing is costly to the breast reconstruction patient and the health care infrastructure. The purpose of this study is to identify potentially modifiable risk factors and to create a model to assess patient risk of these complications.
  
  
  METHODS
  We performed a retrospective study of all free autologous reconstructions at a single institution (2005-2011). Patients with delayed wound healing (operative wounds requiring dressing changes for longer than 3 weeks) were compared to patients with normal healing with respect to history and case characteristics. A risk model was developed to stratify patients based on the multivariate logistic regression results.
  
  
  RESULTS
  Delayed wound healing impacted 297 (44%) of 682 patients. These patients were older (p = 0.02), with higher BMI(p < 0.0001), and higher rates of medical comorbidities (p < 0.001), active smoking (p = 0.02) and bilateral reconstruction (p = 0.02). They received a lower rate/kg of fluid resuscitation intraoperatively (p = 0.001) and more commonly received vasopressors (p = 0.004), with a greater total reconstructive cost (p = 0.003). A regression demonstrated that progressive obesity, smoking, bilateral reconstruction, and utilization of vasopressors were associated with delayed healing (p < 0.05). The final model, with three risk groups (low, intermediate and high) demonstrated that high risk patients have an 86% risk of wound healing complications, compared to a 33% risk in patients with few risk factors.
  
  
  CONCLUSIONS
  While patient disease remains a major predictor of wound complications, potentially modifiable variables including smoking and vasopressor administration impacted this complication. Utilizing the simple model to preoperatively assess patient risk, targeted measures can be undertaken with the goal of ultimately reducing wound healing complications and cost.
authors.affiliation: Division of Plastic Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA. Electronic address: Jonas.Nelson@uphs.upenn.edu.
authors.forename: Jonas A
authors.initials: JA
authors.lastname: Nelson
authors.affiliation: Division of Plastic Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Cyndi U
authors.initials: CU
authors.lastname: Chung
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.affiliation: Division of Plastic Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Suhail K
authors.initials: SK
authors.lastname: Kanchwala
authors.affiliation: Division of Plastic Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Joseph M
authors.initials: JM
authors.lastname: Serletti
authors.affiliation: Division of Plastic Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Liza C
authors.initials: LC
authors.lastname: Wu
mesh_terms: D000367:Age Factors; D015992:Body Mass Index; D015897:Comorbidity; D005260:Female; D005440:Fluid Therapy / Q000009:adverse effects; D006801:Humans; D016462:Mammaplasty / Q000379:methods; D008875:Middle Aged; D015233:Models, Statistical; D011183:Postoperative Complications; D012189:Retrospective Studies; D012307:Risk Factors; D012907:Smoking; D013997:Time Factors; D014662:Vasoconstrictor Agents / Q000009:adverse effects; D014945:Wound Healing / Q000502:physiology*
chemical_list: D014662:Vasoconstrictor Agents
keywords: Autologous breast reconstruction; Breast reconstruction; Outcomes; Wound healing complications