title: Does neoadjuvant chemotherapy affect morbidity, mortality, reoperations, or readmissions in patients undergoing lumpectomy or mastectomy for breast cancer?
abstract: BACKGROUND
  The influence of neoadjuvant chemotherapy (NAC) prior to breast cancer surgery on postoperative complications is unclear. Our objective was to determine whether NAC was associated with postoperative outcomes in patients undergoing lumpectomy or mastectomy without reconstruction.
  
  
  METHODS
  Patients meeting inclusion criteria were identified from the National Surgical Quality Improvement Program (NSQIP) database participant user files from 2005 through 2012, after which NSQIP discontinued the NAC variable. Primary outcome measures included a composite measure of morbidity and mortality (M&M) and reoperations and readmissions within 30 days of the index procedure. Rates of postoperative complications stratified by receipt of NAC were compared by χ2. A logistic regression model was then built that included confounding factors for M&M.
  
  
  RESULTS
  There were 30,309 patients meeting inclusion criteria. NAC was not associated with any postoperative outcomes from 2005 through 2012, but it was associated with higher M&M in lumpectomy patients during 2011 to 2012 [P=0.011, odds ratio (OR) 2.579; 95% confidence interval (CI), 1.239-5.368].
  
  
  CONCLUSIONS
  The finding that NAC was associated with higher M&M in lumpectomy patients during 2011 to 2012 warrants further investigation. Therefore, we recommend that the NSQIP database reinstitute the NAC variable to allow monitoring during anticipated changes in chemotherapy agents and protocols.
authors.affiliation: Department of Medical Research, Gundersen Medical Foundation, La Crosse, Wisconsin, USA.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Landercasper
authors.affiliation: Department of Mathematics, University of Wisconsin-La Crosse, La Crosse, Wisconsin, USA.
authors.forename: Barbara
authors.initials: B
authors.lastname: Bennie
authors.affiliation: Department of Medical Education, Gundersen Medical Foundation, La Crosse, Wisconsin, USA.
authors.forename: Mallory S
authors.initials: MS
authors.lastname: Bray
authors.affiliation: Department of Medical Research, Gundersen Medical Foundation, La Crosse, Wisconsin, USA.
authors.forename: Choua A
authors.initials: CA
authors.lastname: Vang
authors.affiliation: Department of Medical Research, Gundersen Medical Foundation, La Crosse, Wisconsin, USA; ; Department of General Surgery, Gundersen Health System, La Crosse, Wisconsin, USA.
authors.forename: Jared H
authors.initials: JH
authors.lastname: Linebarger
keywords: Mastectomy; mastectomy; mortality; neoadjuvant therapy; postoperative complications; segmental