The National Surgical Quality Improvement Program 30-Day Challenge: Microsurgical Breast Reconstruction Outcomes Reporting Reliability.

BACKGROUND: The aim was to assess reliability of the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) 30-day perioperative outcomes and complications for immediate, free-tissue transfer breast reconstruction by direct comparisons with our 30-day and overall institutional data, and assessing those that occur after 30 days. METHODS: Data were retrieved for consecutive immediate, free-tissue transfer breast reconstruction patients from a single-institution database (2010-2015) and the ACS-NSQIP (2011-2014). Multiple logistic regressions were performed to compare adjusted outcomes between the 2 datasets. RESULTS: For institutional versus ACS-NSQIP outcomes, there were no significant differences in surgical-site infection (SSI; 30-day, 3.6% versus 4.1%, P = 0.818; overall, 5.3% versus 4.1%, P = 0.198), wound disruption (WD; 30-day, 1.3% versus 1.5%, P = 0.526; overall, 2.3% versus 1.5%, P = 0.560), or unplanned readmission (URA; 30-day, 2.3% versus 3.3%, P = 0.714; overall, 4.6% versus 3.3%, P = 0.061). However, the ACS-NSQIP reported a significantly higher unplanned reoperation (URO) rate (30-day, 3.6% versus 9.5%, P < 0.001; overall, 5.3% versus 9.5%, P = 0.025). Institutional complications consisted of 5.3% SSI, 2.3% WD, 5.3% URO, and 4.6% URA, of which 25.0% SSI, 28.6% WD, 12.5% URO, and 7.1% URA occurred at 30-60 days, and 6.3% SSI, 14.3% WD, 18.8% URO, and 42.9% URA occurred after 60 days. CONCLUSION: For immediate, free-tissue breast reconstruction, the ACS-NSQIP may be reliable for monitoring and comparing SSI, WD, URO, and URA rates. However, clinicians may find it useful to understand limitations of the ACS-NSQIP for complications and risk factors, as it may underreport complications occurring beyond 30 days.

Evaluation of Contralateral and Bilateral Prophylactic Mastectomy and Reconstruction Outcomes: Comparing Alloplastic and Autologous Reconstruction.

BACKGROUND: Over the last decade, there has been a 12% increase in prophylactic mastectomy (PM) per year. The aim of the study was to analyze complication rates and associated risk factors in patients undergoing PM and reconstruction. METHODS: We reviewed patients undergoing PM (contralateral and bilateral) from 2010 to 2015 at a single academic institution. Data on patient characteristics and postoperative outcomes were obtained. Postoperative complications were categorized into minor and major groups. We compared complication rates between autologous and alloplastic reconstruction. Patient characteristics were assessed using univariable and multivariable models. RESULTS: Reconstruction after PM was performed on 390 breasts over the study period: 214 underwent autologous and 176 underwent alloplastic reconstruction. When comparing autologous and alloplastic reconstruction, significant differences were seen between the number of immediate breast reconstructions (96.3% vs 48.9%, P < 0.001, respectively) and 2-stage reconstructions (0.5% vs 44.9%, P < 0.001, respectively). The overall complication rate was 15.9%: 14.6% were minor complications, and 6.9% were major. Autologous reconstruction compared with alloplastic reconstruction had a lower incidence of minor complications (11.2% vs 18.8%, P = 0.036), breast infection (1.9% vs 13.1%, P < 0.001), and breast seroma (2.3% vs 7.4%, P = 0.018), respectively. Risk factors for complications included age (≥65), obesity, American Society of Anesthesiology class (≥3), smoking, hypertension, anxiety, tissue expander (with acellular dermal matrix), and implant-only reconstructions. CONCLUSION: In our study, autologous reconstruction appeared to have a better complication profile than alloplastic reconstruction. Clinicians may potentially use this information to guide preoperative counseling of women considering PM and reconstruction.

Comparison of risk factors and complications in patients by stratified mastectomy weight: An institutional review of 1041 consecutive cases.

BACKGROUND AND OBJECTIVES: This study aims to investigate the specific complication rates, reconstructive differences, and delineate the pertinent independent risk factors in patients with different mastectomy weights. METHODS: A retrospective chart review of consecutive patients undergoing mastectomy between 2010 and 2015 was performed. Patient demographics, comorbidities, and intraoperative and postoperative outcomes were collected. Patients were divided into three groups: those with mastectomy weight <500, 500-1000, and >1000 g. RESULTS: During the study period, a total of 704 consecutive patients and 1041 total mastectomy surgeries had complete mastectomy specimen weight data. Of these, 437 breasts were in the <500 g specimen group, 425 were included in the 500-1000 g group and 179 in the >1000g group. The rate of overall complications between the three mastectomy weight groups (<500, 500-1000, and >1000 g) was statistically significant (14.0%, 17.6%, and 25.7%; P = 0.002, respectively) and were higher with increased mastectomy weights. Notably, in patients with breast mastectomy weight >1000 g, autologous reconstruction had significantly reduced rates of overall complications (AOR = 0.512, P = 0.048). CONCLUSION: Complication rates were lower in women with larger breast weights undergoing autologous reconstruction, warranting potential use of autologous free flap breast reconstruction in women with large mastectomy specimen weights when possible.