The impact of metabolic syndrome in breast reconstruction decision-making and postoperative outcomes: A nationwide analysis

Maria J Escobar-Domingo; Valeria P Bustos; Erin J Kim; Tessa Campbell; James E Fanning; Jose A Foppiani; Chamilka Merle; Samuel J Lin; Bernard T Lee

doi:10.1016/j.bjps.2023.11.042

The impact of metabolic syndrome in breast reconstruction decision-making and postoperative outcomes: A nationwide analysis

J Plast Reconstr Aesthet Surg. 2024 Feb:89:21-29. doi: 10.1016/j.bjps.2023.11.042. Epub 2023 Nov 29.

Authors

Maria J Escobar-Domingo¹, Valeria P Bustos², Erin J Kim¹, Tessa Campbell¹, James E Fanning¹, Jose A Foppiani¹, Chamilka Merle¹, Samuel J Lin³, Bernard T Lee⁴

Affiliations

¹ Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
² Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Miami, Miami, FL, USA.
³ Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA. Electronic address: sjlin@bidmc.harvard.edu.
⁴ Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA. Electronic address: blee3@bidmc.harvard.edu.

PMID: 38128370
DOI: 10.1016/j.bjps.2023.11.042

Abstract

Background: Metabolic syndrome (MetS) is a cluster of cardiometabolic abnormalities including hypertension, obesity, insulin resistance, and dyslipidemia. The safety profiles of patients with MetS undergoing breast reconstruction remain underreported. This study aims to evaluate the impact of MetS on the BR decision-making process and postoperative complication rates.

Methods: The ACS-NSQIP database was utilized to identify women who underwent BR between 2012 and 2021. Baseline characteristics were compared based on the presence of MetS, defined as patients receiving medical treatment for diabetes mellitus and hypertension, with a body mass index greater than 30 kg/m². Group differences were assessed using t tests and Fisher's exact tests. Multivariate logistic regression models evaluated postoperative complications between the groups.

Results: A total of 160,115 patients underwent BR. A total of 4570 had a diagnosis of MetS compared to 155,545 without MetS. No statistically significant differences were observed in the type of BR patients received across cohorts. Logistic regression models demonstrated a higher likelihood of postoperative wound complications (OR 2.21; 95% CI 1.399, 3.478; p = 0.001), and readmission rates (OR 2.045; 95% CI 1.337, 3.128; p = 0.001) in the MetS group compared to the non-MetS patients. No significant differences were identified in other postoperative complications between groups.

Conclusions: Patients with MetS appear to have an increased risk of postoperative wound complications and readmission after breast reconstruction. The synergistic effects of these comorbidities on postoperative outcomes underscore the importance of addressing MetS as a holistic condition and considering choosing Delayed breast reconstruction over Immediate Breast Reconstruction in this population. Thus, integrating MetS management and patient counseling at various stages of BR may improve outcomes and facilitate patient decision-making.

Keywords: Breast neoplasm; Mammoplasty; Mastectomy; Metabolic syndrome; Obesity; Wound healing.

MeSH terms

Breast Neoplasms* / complications
Comorbidity
Female
Humans
Hypertension* / epidemiology
Mammaplasty* / adverse effects
Metabolic Syndrome* / complications
Metabolic Syndrome* / epidemiology
Postoperative Complications / epidemiology
Postoperative Complications / etiology
Retrospective Studies