title: Burden of preoperative cardiovascular disease risk factors on breast cancer surgery outcomes.
abstract: BACKGROUND
  Cardiovascular comorbidities have been studied sporadically in breast cancer surgery. No study has provided a comprehensive assessment of the severity and relative influence of preoperative cardiac risk factors on surgical outcomes.
  
  
  METHODS
  78,338 breast cancer surgery patients were identified from the 2006 to 2012 National Surgical Quality Improvement Program (NSQIP) database. We estimated the impact of chronic conditions (diabetes, hypertension, obesity, smoking), acute cardiac events (myocardial infarction, congestive heart disease, angina), and past cardiac procedures (cardiac surgery, percutaneous coronary intervention) on 30-day postoperative complications, reoperation, and readmission.
  
  
  RESULTS
  Nearly 65% of patients had chronic conditions, <1% had acute events, and 3% had past procedures. The prevalence of outcomes was low: 5% had complications, 4% underwent reoperation, and 4% were readmitted. Over 65% of complications were wound-related. All risk factor categories were associated with complications (ORs from 1.26 to 4.18). Acute events had the strongest effect on overall (OR 3.54, CI 2.55-4.91) and medical (OR 4.18, CI 2.73-6.41) complications. Chronic conditions and past procedures also predicted reoperation and readmission (ORs from 1.57 to 2.68). The odds of all outcomes increased with the number of chronic conditions (ptrend  < 0.001).
  
  
  CONCLUSIONS
  Cardiovascular disease has a significant impact on outcomes even in minimal-risk breast cancer surgery. J. Surg. Oncol. 2016;114:144-149. © 2016 Wiley Periodicals, Inc.
authors.affiliation: The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.|Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California.
authors.forename: Brian Z
authors.initials: BZ
authors.lastname: Huang
authors.affiliation: The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.|Department of Surgery, Johns Hopkins Medicine, Baltimore, Maryland.
authors.forename: Melissa S
authors.initials: MS
authors.lastname: Camp
mesh_terms: D001943:Breast Neoplasms / Q000601:surgery*; D002318:Cardiovascular Diseases / Q000150:complications*; D002908:Chronic Disease; D017281:Cost of Illness; D005260:Female; D006801:Humans; D016015:Logistic Models; D008408:Mastectomy; D008875:Middle Aged; D010359:Patient Readmission; D011183:Postoperative Complications; D012086:Reoperation; D012307:Risk Factors; D016896:Treatment Outcome
keywords: 30-day postoperative outcomes; breast cancer surgery; cardiovascular disease; complications; readmission; reoperation