Worse Overall Health Status Negatively Impacts Satisfaction With Breast Reconstruction
Sumarth K. Mehta, B.S., Olamide Olawoyin, B.S., Fouad Chouairi, B.S., John Persing, M.D., Michael Alperovich, M.D., M.Sc..
Yale School of Medicine, New Haven, CT, USA.
PURPOSE: BREAST-Q is a validated measure of patient satisfaction and health-related quality of life following breast surgery. Limited evidence exists regarding the influence of preoperative overall health status on BREAST-Q outcomes. ASA physical status classification is representative of preoperative overall health and its impact on patient-reported outcomes can be assessed.
METHODS: Patients who received breast reconstruction at Yale New Haven Hospital between 2013 and 2018 and completed the BREAST-Q were enrolled in the study. Associations between BREAST-Q scores and ASA were analyzed. Pearson correlation and Spearman's Rho were used to characterize correlations between ASA and patient factors. A General Linear Model (GLM) was used to control for confounding variables and isolate the effect of ASA on BREAST-Q scores.
RESULTS: 489 patients completed the BREAST-Q survey. Increasing ASA indicative of worsening overall health was associated with a decreased BREAST-Q score for all modules except Physical Wellbeing of Abdomen (p<0.01 to p=0.029). In a GLM controlling for relevant covariates, ASA remained a significant contributor for all modules except Physical Wellbeing of the Chest (p<0.01 to p=0.021). BREAST-Q scores decreased by approximately twice as much from ASA 1 to 2 compared to ASA 2 to 3.
CONCLUSION: ASA classification is an independent predictor of BREAST-Q patient-reported outcomes following breast reconstruction. Communicating the potential impact of overall health may help reduce the discrepancy in post-operative satisfaction across ASA classifications.
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