PRS AAPS Oral Proofs 2016
Edwin G. Wilkins, MD, MS,* Andrea L. Pusic, MD, MHS,† H. Myra Kim, ScD,* Jennifer B. Hamill, MPH,* Ji Qi, MS*
From the *University of Michigan, Ann Arbor, Mich.; and †Memorial Sloan-Kettering Cancer Center, New York, N.Y.
PURPOSE: In postmastectomy reconstruction, procedure choice is heavily influenced by the relative risks of the various options. We evaluated complications in a large, multicenter population of breast reconstruction patients.
METHODS: Eleven sites enrolled women undergoing first time, immediate, or delayed reconstruction after mastectomy for cancer treatment or prophylaxis. Procedures included implant-based latissimus dorsi, pedicle TRAM, free TRAM (FTRAM), and DIEP reconstructions. Clinical and demographic data were gathered preoperatively and postoperatively from medical records. Separate logistic regressions were conducted for all complications and major complications (requiring rehospitalization and/or reoperation) within 1 year. Odds ratios (ORs) were calculated for procedure, controlling for site, demographic, and clinical variables.
RESULTS: Complication rates for 1895 patients are summarized below. Regression indicated that compared with implant-based reconstruction, latissimus dorsi (OR = 2.02, P = 0.032), pedicle TRAM (OR = 1.96, P = 0.028), FTRAM (OR = 2.24, P = 0.004), and DIEP (OR = 2.19, P < 0.0001) procedures were associated with higher risks of complications. Significantly higher risks were also associated with older age, higher body mass index, immediate reconstruction, bilateral procedures, and radiation. For major complications, regression showed significantly greater risks for FTRAM (OR = 2.07, P = 0.016) and DIEP (OR = 1.76, P = 0.011) compared with implant-based reconstructions. Significant effects were noted for age, body mass index, laterality, and radiation.
CONCLUSIONS: In this multicenter study, procedure choice and other patient variables were significant predictors of 1-year complications. These findings should be considered in counseling patients on breast reconstruction options.