Effect of Obesity and Its Associated Cost in Autologous Breast Reconstruction
Bao Ngoc Tran, MD, Ryan Cauley, MD, Bernard Lee, MD, MPH, MBA.
Beth Israel Deaconess Medical Center, Boston, MA, USA.
PURPOSE: Obesity has been identified as independent risk factor for complications in surgical outcomes. This study aims to quantify the effects of obesity and its associated costs in autologous breast reconstruction outcomes.
METHODS: A retrospective review was performed on patients undergoing abdominal based microsurgical breast reconstruction at an academic institution (2004-2015). Patient were divided into 5 different groups based on their body mass index (BMI), normal (<25), pre-obese (25-29.99), obese I (30-34.99), obese II (35-39.99), obese III (>40) based on World Health Organization Body Mass Index Classification. Complication data was extracted and complication-associated costs were calculated. Total cost, which was a sum of baseline cost and complication costs, was compared among the five groups.
RESULTS: There were 283 (33%) patients with normal BMI, 306 (36%) pre-obese, 184 (21.5%) obese I, 60 (7%) obese II, and 22 (2.5%) obese III. Statically significant findings include higher rates of donor wound dehiscence, infection, seroma, breast infection, umbilical necrosis, and readmission in all four obese groups. Compared to the group with normal BMI, the pre-obese group incurred an additional $399.76 and similarly the obese I $359.54, obese II $1,574.37, obese III $440.64.
CONCLUSION: This study quantified the disadvantageous effect of obesity in autologous breast reconstruction and its corresponding incremental costs. Most complications were related to wound healing and infection. Risk reduction strategies are needed to optimize patient outcomes.
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