Hepatitis B And C Is Associated With Greater Postoperative Complications Following Mastectomy And Breast Reconstruction
Olachi O. Oleru, BS1, Ishani D. Premaratne, BA2, Christine H. Rohde, MD, MPH, FACS3.
1State University of New York (SUNY), Downstate Medical Center, New York, NY, USA, 2Weill Cornell Medicine, New York, NY, USA, 3Columbia University Medical Center, New York, NY, USA.
PURPOSE: Prior studies have analyzed the effects of Hepatitis B and C (HB and HC) on outcomes following hepatic surgeries. Fewer have investigated this association in plastic and reconstructive surgeries. We present a large-scale database analysis of outcomes following mastectomy and breast reconstruction in patients with HB/HC compared to patients without infectious hepatitis.
METHODS: Data from the New York State Statewide Planning and Research Cooperative System (NYS SPARCS) from 2008-2013 was queried. Patients with confirmed HB and/or HC who underwent mastectomy and/or breast reconstruction procedures (identified using International Classification of Disease [ICD-9] codes) were compared to propensity-score matched patients without HB or HC who underwent these procedures to assess differences in post-surgical outcomes. Univariate analysis assessed differences in demographic information, baseline health characteristics, and perioperative factors as possible risk factors. Post-surgical outcomes were assessed by collecting infection rate, re-operation rate, postoperative complications, and length of hospital stay. Multivariate analysis revealed the effects of the possible risk factors on postoperative outcomes.
RESULTS: 36,072 patients were identified. The majority (35,898) had no history of HB/HC infection, and 174 patients had documented history of HB/HC. There was no difference in age between the cohorts (56.3 vs. 56.6 years for non-HB/HC and HB/HC patients, respectively). The majority of patients were female (98.6% of non-HB/HC, 95.9% of HB/HC patients, p=0.005). There were significantly more Black/African American, Native American/Alaska Native, and Asian patients in the HB/HC cohort (p<0.001). Insurance types also differed with a larger proportion of HB/HC patients utilizing Medicaid (37.9% vs. 12.0%, p<0.001). Hepatitis patients had more frequent comorbid HIV/AIDS, deficiency anemias, chronic pulmonary disease, coagulopathies, depression, diabetes without complications, drug abuse, hypertension, fluid/electrolyte disorders, psychoses, and renal failure (p<0.04). These were used as covariates in the multivariate analysis. HB and HC patients had a higher incidence of postoperative hemorrhage (8.0% vs. 3.1%, p<0.01), urinary system complications (1.1% vs. 0.3%, p=0.030), death during hospitalization (0.6% vs. 0.1%, p=0.003), and a lengthier overall hospital stay (2.39 vs. 2.84 days, p=0.03). Other complication rates were comparable, including shock, infection, and cardiac, respiratory, and digestive complications. HB and HC patients were more likely to have any postoperative complication (10.3% vs. 5.4%, p=0.004), and to have two or more postoperative complications (1.7% vs. 0.4%, p=0.008). Multivariate analysis revealed that HB/HC patients had greater odds of postoperative hemorrhage (OR=2.45, 95% CI 1.39-4.32, p=0.002) and greater odds of having at least one postoperative complication (OR=1.72, 95% CI 1.04-2.87, p=0.03).
CONCLUSION: Patients with comorbid HB and/or HC had greater postoperative complications after undergoing mastectomy and breast reconstruction procedures compared to similar patients without HB and/or HC. They had greater odds of postoperative hemorrhage and of developing postoperative complications overall. They were more likely to be ethnic minorities and to be supported by Medicaid. Our results reveal that hepatitis infection may be an understudied contributor to historically demonstrated racial and insurance-based differences in operative complication rates.
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