Plastic Surgery Research Council
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PSRC 60th Annual Meeting
Program and Abstracts

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The Effect of Timing on Breast Reconstruction Outcomes in Diabetic Women: A Comparison of NSQIP and Johns Hopkins Patient Data
Melanie Major, BS, Chris Devulapalli, MD, Ricardo Bello, MD, Carisa M. Cooney, MPH, Gedge Rosson, MD.
Johns Hopkins University School of Medicine, Baltimore, MD, USA.

Purpose: We sought to determine the effect of timing (immediate versus delayed) on post-operative morbidity in diabetic women undergoing breast reconstruction following mastectomy.
Methods: We reviewed the National Surgical Quality Improvement Program (NSQIP) databases from 2005-2012 for all diabetic women undergoing breast reconstruction. Univariable and multivariable logistic regression was used to estimate the risk of 30-day complications in the immediate versus delayed breast reconstruction groups. Additionally, we retrospectively reviewed Johns Hopkins Hospital (JHH) diabetic patients undergoing breast reconstruction from 2005-2014. We used Fischer’s exact test to estimate the association of timing of reconstruction with both 60-day and long-term complications.
Results: In NSQIP, 1,408 diabetic women underwent breast reconstruction: 958 (68%) immediate and 450 (32%) delayed. Pre-operative comorbidities between the two groups were not statistically different. In the immediate group, 10.8% of patients developed a 30-day post-operative complication whereas 7.8% of patients in the delayed group developed a complication, which trended toward statistical significance (p=0.08, 95% CI). After adjusting for age, smoking status, inpatient status, type of reconstruction, preoperative anemia, and year of operation the odds of developing 30-day complications were significantly higher (adjusted OR = 1.68, 95% CI 1.04 - 2.72) for the immediate group compared to the delayed group (p=0.033). This association persisted with statistical significance for 30-day surgical morbidity (adjusted OR = 1.75, 95% CI 1.06 - 2.9; p=0.029) but not for 30-day medical morbidity (adjusted OR = 0.93, 95% CI 0.25 - 3.42; p=0.914).
In the JHH cohort, 117 reconstructions were performed in 52 diabetic women: 60 (51%) immediate and 57 (49%) delayed. Among immediate reconstructions, 30% developed 60-day complications compared to 10.5% of delayed reconstructions (p=0.012, 95% CI). In the long-term (median follow up 9 months, range 0.5 - 94 months), 35% of immediate reconstructions developed a complication, compared to 12.3% of delayed reconstructions (p=0.005). Surgical morbidity was significantly higher for the immediate reconstruction group, particularly for deep incisional surgical site infections (SSI) at 60-day and long-term follow up, and for reconstruction failure and seroma at long-term follow up (Table 1). Reoperation was significantly increased in immediate reconstructions compared to delayed reconstructions at 60-day (p=0.003, 95% CI) and long-term (p<0.001, 95% CI) follow up.
Conclusions: Among diabetics seeking breast reconstruction, delaying the reconstructive surgery from the mastectomy may optimize outcomes by decreasing postoperative morbidity. It also appears the 30-day postoperative time point available in NSQIP does not fully reflect the magnitude of the long-term complications these diabetic patients will develop.



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