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A Recent National Analysis Of Breast Reconstruction Outcomes In Patients With Underlying Autoimmune Connective Tissue Diseases
Mallory Rowley, BA1, Kometh Thawanyarat, BA2, Jennifer Shan, BS3, Rahim Nazerali, MD, MHS4.
1SUNY Upstate Medical University, Syracuse, NY, USA, 2Medical College of Georgia at Augusta University, Augusta, GA, USA, 3Stanford University, Palo Alto, CA, USA, 4Stanford University School of Medicine, Palo Alto, CA, USA.

PURPOSE: Autoimmune connective tissue diseases (CTDs) have been implicated in postoperative complications and adverse medical events in patients undergoing both autologous and implant-based breast reconstruction. Previously reported complications from patients with autoimmune CTDs who underwent breast reconstruction from 2008-2014 demonstrated higher rates of wound dehiscence, bleeding, seroma and infection. To the best of our knowledge, this is the first study that aims to characterize post-operative complication rates in patients with underlying CTDs using a larger and more recent sample size.
METHODS: Using the Clinformatics® Data Mart Database, a national de-identified commercial claims data warehouse, adult female patients from 2003-2021 were queried. Common procedural terminology codes were used to identify those who underwent autologous and implant-based reconstruction, and International Classification of Disease (ICD-9 and ICD-10) codes were used to identify patients with autoimmune connective tissue disorders (CTDs), including systemic lupus erythematosus, rheumatoid arthritis, systemic sclerosis, Sjögren’s, sarcoidosis, spondyloarthritides, antiphospholipid syndrome, psoriatic arthritis, dermatomyositis, polymyositis, and large, medium or small vessel vasculitides. Patient demographics and complications requiring and not requiring surgical intervention were recorded. Patients not continuously enrolled for at least 6 months before and after the index procedure were excluded. Scapiro-Wilk, chi squared, Mann-Whitney-Wilcoxon, and multivariable regression tests were used for statistical analysis.
RESULTS: Of 33,477 patients meeting criteria (mean age 53.1 ± 11.6 years), 5,261 (15.7%) had a CTD diagnosis. On average, those with a CTD diagnosis were less likely to undergo autologous breast reconstruction (OR 0.864; p = 0.007) and were more likely to experience one or more complications as a result of the index reconstruction procedure (OR 1.127; p = 0.019). Rates of vascular complications (p = 0.002), breast reconstruction deformities (p = 0.001), and revisions of breast reconstruction (p = 0.008) were significantly higher among those with a CTD diagnosis. Length of stay was longer among patients with a CTD diagnosis (p = 0.009).
CONCLUSION: Vascular complications remain a concern in patients with underlying CTDs and the possibility of deformity following reconstruction should be included in pre-operative discussions in this patient population. However, wound dehiscence and post-operative infections not as prevalent as previously reported in the literature and other rates of complications are comparable to the non-CTD population, suggesting that emphasis on optimization of thromboembolism prophylaxis should be the focus when offering breast reconstruction to patients with CTDs.


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