Influence of Preoperative Weight Loss in Mastectomy: Proxy for Expectations in Breast Reconstruction
Kevin T. Jubbal, MD1, Dmitry Zavlin, MD2, Michael E. Hill, MD, PhD1, Subhas Gupta, MD, PhD1.
1Loma Linda University, Loma Linda, CA, USA, 2Houston Methodist Hospital, Houston, TX, USA.
In patients undergoing mastectomy and breast reconstruction, a healthy physiological state and proper nutritional status are important prerequisites for favorable postoperative outcomes. To assess a patient's preoperative status, surgeons may utilize body mass index (BMI), serum electrolytes, and blood albumin levels as a proxy for nutritional well-being. Preoperative weight change serves as another measurement of interest for certain high-risk populations. In setting patient expectations for outcomes in mastectomy and breast reconstruction procedures, it is therefore critical to understand the complication profiles, nutrition status, and associated clinically pertinent risk factors. The purpose of this study was to evaluate the outcomes of patients with preoperative weight loss undergoing mastectomy procedures.
A retrospective analysis of the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) was performed between the years 2005 and 2015. Current Procedural Terminology (CPT) codes were used to identify patients undergoing mastectomy procedures. Patients were divided into two cohorts: those with and without greater than ten percent weight loss in the preoperative six months.
A total of 97,396 cases were identified. Age was greater in the weight loss group (61.2 vs 57.8) while BMI was lower (25.7 vs 28.5). The weight loss group revealed greater proportions of emergency cases (1.0% vs 0.3%), American Society of Anesthesiologists (ASA) classification 3, 4, and 5, shorter average operative time (140.5 vs 163.8 minutes), more modified radical mastectomy procedures (43.5% vs 29.3%), and a longer average length of stay (2.7 vs 1.7 days). Factors associated with medical and surgical complications included increasing age, increasing BMI, preoperative open wound or infection, history of respiratory disease, bleeding disorder, ASA class of 3 or greater, and inpatient procedure setting. History of smoking and diabetes were associated with surgical complications. Weight loss greater than ten percent body weight in the preoperative 6 months was associated with medical complications. High preoperative serum albumin was protective of medical and surgical adverse events.
Weight loss greater than ten percent in the six months preceding mastectomy is associated with an increased risk of medical complications in the thirty days following surgery. Plastic surgeons need to be aware of this high-risk mastectomy population when reconstructive options are being considered.
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