Tracking Outcomes in Breast Reduction: An Analysis of 6,570 Patients Using the TOPS Database
Jeffrey M. Smith, M.D., Stefanos Boukovalas, M.D., John Hamati, B.S., Pablo Padilla, M.D., Clark Andersen, M.S., Julie E. Park, M.D., Linda G. Phillips, M.D.
UTMB, Galveston, TX, USA.
PURPOSE: Reduction mammaplasty is considered to be standard of care for symptomatic macromastia. The purpose of this study is to identify patient- and practice-specific variables that affect the incidence of adverse events, aiming to optimize patient safety and outcomes.
METHODS: The TOPS registry was queried for patients undergoing reduction mammaplasty from 2009 to 2016. The primary outcomes examined were the incidence of any adverse event and wound dehiscence alone in the first 30 post-operative days. Logistic regression analyses were performed to identify potential factors associated with adverse outcomes and wound dehiscence.
RESULTS: 6,570 patients were included. Logistic regression analyses identified that the following factors were associated with a significantly increased incidence of adverse events: BMI (OR=1.054, CI=1.04-1.069), duration of surgery (1.119, 1.036-1.209), tobacco use (1.946, 1.494-2.534), mild systemic ASA status (1.395, 1.134-1.715), and severe systemic ASA status (2.25, 1.55-3.267). Surgery in an office as opposed to an acute care hospital was associated with 2.5 times the odds of adverse events (2.507, 1.013-6.203), despite expected selection of patients with lower risk factors. Surgery in an ambulatory surgical center was associated with a 30% reduction in the odds of adverse events compared to an acute care hospital (0.704, 0.565-0.876). There was no significant association between adverse events and history of massive weight loss. The same factors were identified to be associated with wound dehiscence.
CONCLUSION: Adverse events associated with breast reduction were affected by both patient- and practice-specific variables. Knowledge of potential risk factors can optimize patient counseling and outcomes.
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