title: Post-mastectomy breast reconstruction and its subsequent complications: a comparison between obese and non-obese women with breast cancer.
abstract: To compare the utilization pattern of breast reconstruction between obese and non-obese patients and assess the association between obesity and postoperative complications as well as healthcare costs. Using MarketScan databases, we identified 2558 breast cancer patients who underwent mastectomy between 2009 and 2012. Temporal trends in breast reconstruction were assessed using the Cochran-Armitage test. Logistic regression models were performed to determine the association between obesity and the occurrence of postoperative complications. Healthcare costs were compared using a generalized linear model. Among 2558 patients treated with mastectomy, the breast reconstruction rate of non-obese patients (76.2 %) was significantly higher than patients in obese class I and class II&III (63.3 and 60.2 %, respectively; P < 0.001). Compared with non-obese patients, obese patients had significantly higher rates of infection (OR 1.53, for obese class I, and OR 1.60, for obese class II&III, both P < 0.01), wound (OR 1.51, P = 0.01 for obese class I, and OR 1.98, P < 0.001 for obese class II&III), and perfusion complications (OR 1.73, P = 0.01 for obese class I, and OR 2.21, P < 0.01 for obese class II&III). The mean postoperative complication cost for non-obese patients ($4684) was significantly lower than those for obese class I patients ($6250) and obese class II&III patients ($7868; P < 0.001). Our analysis demonstrated a significant gap in breast reconstruction between obese and non-obese patients, and our finding underscores the need for careful preoperative assessment of obese patients and call for additional research to minimize the risk of complications.
authors.affiliation: Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Jinhai
authors.initials: J
authors.lastname: Huo
authors.affiliation: Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.|Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Benjamin D
authors.initials: BD
authors.lastname: Smith
authors.affiliation: Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.|Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Sharon H
authors.initials: SH
authors.lastname: Giordano
authors.affiliation: Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Gregory P
authors.initials: GP
authors.lastname: Reece
authors.affiliation: Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. yashih@mdanderson.org.
authors.forename: Ya-Chen Tina
authors.initials: YT
authors.lastname: Shih
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000191:economics / Q000601:surgery*; D005260:Female; D017048:Health Care Costs; D006801:Humans; D007345:Insurance Claim Review; D016015:Logistic Models; D016462:Mammaplasty / Q000009:adverse effects* / Q000191:economics; D008408:Mastectomy / Q000191:economics / Q000379:methods; D008875:Middle Aged; D009765:Obesity / Q000150:complications* / Q000191:economics; D011183:Postoperative Complications / Q000191:economics / Q000453:epidemiology*; D055815:Young Adult
keywords: Breast cancer; Breast reconstruction; Complications; Healthcare costs; Mastectomy; Obese