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Synergistic Interaction Increases Complication Rates Following Microvascular Breast Reconstruction

Roy, Mélissa MDCM1,2; Sebastiampillai, Stephanie HBSc2; Zhong, Toni MD MHS1,2; Hofer, Stefan O P MD PhD1,2; O’Neill, Anne C MBBCh PhD1,2

Plastic and Reconstructive Surgery: April 9, 2019 - Volume PRS Online First - Issue - p
doi: 10.1097/PRS.0000000000005695
Original Article: PDF Only

Background: Microvascular breast reconstruction is a complex procedure that can be associated with high complication rates. While a number of individual predictors of peri-operative complications have been identified, few studies have explored interaction between risk factors. Understanding the synergistic effects of multiple risk factors is central to accurate and personalized pre-operative risk prediction.

Methods: We conducted a retrospective cohort study of patients who underwent microvascular breast reconstruction at our institution between 2009 and 2017. All intra- and post-operative complications were recorded. A multivariable logistic regression exploratory model identified independent predictors of complications. Interactions between individual variables were then assessed using the Relative Excess Risk Index (RERI) and Synergy Index (SI).

Results: Nine hundred and twelve patients were included in the study and 26.1% experienced at least one peri-operative complication. Obesity (OR1.54, p=0.009), immediate reconstruction (OR1.49, p=0.028), and comorbidities (OR1.43, p=0.033) were identified as independent predictors of complications. Obesity and comorbidities had significant synergistic interactions with immediate reconstruction (RERI 0.86, SI 2.35, p=0.0002; RERI 0.54, SI 1.78, p=0.001), bilateral reconstruction (RERI 0.12, SI 1.15, p=0.002; RERI 0.59, SI 3.16, p=0.005) and previous radiotherapy (RERI 0.62, SI 4.43, p=0.01; RERI 0.11, SI 1.23, p=0.040). Patients undergoing immediate breast reconstruction who were both obese and smokers had a 12-fold increase in complication rates (OR 12.68, 95% CI 1.36-118.46, p=0.026) with a very strong synergistic interaction between variables (RERI 10.55, SI 10.33).

Conclusions: Patient and treatment related variables interact in a synergistic manner to increase the risk of complications following microvascular breast reconstruction.

1Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada

2Division of Plastic and Reconstructive Surgery, University Health Network, University of Toronto, Toronto, ON, Canada

Funding: None.

The authors declare no conflict of interest.

Presented at: Canadian Society of Plastic Surgeons, Annual Meeting, Jasper, Alberta, Canada, June 20, 2018.

Correspondence and reprints: Dr. Anne C O’Neill, Division of Plastic and Reconstructive Surgery, Toronto General Hospital, 200 Elizabeth Street, 8N-866, Toronto, Ontario, M5G 2C4 Phone: (416) 340-3143, Fax: (416) 340-4403, Email: anne.o'

©2019American Society of Plastic Surgeons