title: Early Postoperative Outcomes in Breast Conservation Surgery Versus Simple Mastectomy with Implant Reconstruction: A NSQIP Analysis of 11,645 Patients.
abstract: BACKGROUND
  Little has been studied that compares early postoperative outcomes between breast conservation surgery (BCS) and simple mastectomy with implant reconstruction (SM). Our goal was to utilize a large-volume database to compare such outcomes in women with early stage breast cancer.
  
  
  METHODS
  The National Surgery Quality Improvement Program (NSQIP) database was searched for patients who underwent partial or complete mastectomy between 2009 and 2012. Exclusion criteria eliminated potential confounding factors. We compared preoperative comorbidities and postoperative complication rates between each treatment group by Chi square and two-sample t tests; we also determined the odds ratios for the likelihood of adverse events in a number of categories.
  
  
  RESULTS
  A total of 11,645 patients met the study criteria: 9571 underwent BCS and 2074 underwent SM with implant reconstruction. The baseline characteristics of the two groups showed significant differences for age (61.7 years in BCS, 53.5 years in SM), body mass index (29.6 kg/m(2) in BCS, 27.0 kg/m(2) in SM), and rates of hypertension (47.0 % in BCS, 25.6 % in SM), coronary artery disease (1.3 % in BCS, 0.6 % in SM), chronic obstructive pulmonary disease (2.4 % in BCS, 1.0 % in SM), and diabetes (11.7 % in BCS, 5.9 % in SM). Statistical analysis between each treatment modality revealed that the SM with implant group had significantly higher total complication (5.5 vs. 2.1 % in BCS), wound (2.8 vs. 1.4 % in BCS), infection (1.9 vs. 0.4 % in BCS), and bleeding (0.2 vs. 0.05 % in BCS) rates than the BCS group.
  
  
  CONCLUSIONS
  BCS has fewer overall early postoperative wound, infectious, and bleeding complications despite a significantly higher rate of preexisting risk factors.
authors.affiliation: Department of Surgery, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA. bryanpyfer@gmail.com.
authors.forename: Bryan
authors.initials: B
authors.lastname: Pyfer
authors.affiliation: Department of Surgery, University of Pennsylvania Health System, Philadelphia, PA, USA.
authors.forename: Abhishek
authors.initials: A
authors.lastname: Chatterjee
authors.affiliation: Department of Surgery, Lahey Hospital and Medical Center, Burlington, MA, USA.
authors.forename: Lilian
authors.initials: L
authors.lastname: Chen
authors.affiliation: Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA.
authors.forename: John
authors.initials: J
authors.lastname: Nigriny
authors.affiliation: Department of Surgery, University of Pennsylvania Health System, Philadelphia, PA, USA.
authors.forename: Brian
authors.initials: B
authors.lastname: Czerniecki
authors.affiliation: Department of Surgery, University of Pennsylvania Health System, Philadelphia, PA, USA.
authors.forename: Julia
authors.initials: J
authors.lastname: Tchou
authors.affiliation: Department of Surgery, University of Pennsylvania Health System, Philadelphia, PA, USA.
authors.forename: Carla
authors.initials: C
authors.lastname: Fisher
mesh_terms: D001943:Breast Neoplasms / Q000473:pathology / Q000601:surgery*; D016208:Databases, Factual; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008408:Mastectomy / Q000009:adverse effects*; D015412:Mastectomy, Segmental / Q000009:adverse effects*; D008875:Middle Aged; D009367:Neoplasm Staging; D011183:Postoperative Complications; D011379:Prognosis; D058996:Quality Improvement; D019651:Plastic Surgery Procedures / Q000009:adverse effects*; D012307:Risk Factors