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Risk Factors for Postoperative Bleeding Following Breast Cancer Surgery: A Nationwide Database Study of 477,108 Cases in Japan

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Abstract

Background

Although postoperative bleeding is a common and serious complication in breast cancer surgery, the risk factors remain unclear. Therefore, we examined the risk factors using a Japanese nationwide database.

Methods

Patients who underwent breast cancer surgery between July 2010 and March 2020 were identified from a Japanese nationwide database. Multivariable analyses for 47 candidate risk factors (4 patient characteristics, 32 comorbidities, 5 tumor characteristics, 3 preoperative drug uses, and 3 surgical procedures) were conducted to investigate risk factors associated with postoperative bleeding requiring reoperation. Two sensitivity analyses were conducted: an analysis for postoperative bleeding with or without reoperation and an analysis for patients who underwent total mastectomy without breast reconstruction.

Results

Among the 477,108 patients included, 7048 (1.5%) developed postoperative bleeding and 2357 (0.5%) underwent reoperation for postoperative bleeding. Male sex, old age, body mass index ≥ 25.0 kg/m2, several comorbidities (deficiency anemia, cardiac arrhythmias, hypertension, liver disease, psychoses, and valvular disease), preoperative heparin use, and several procedures were identified as risk factors. Deficiency anemia showed the highest odds ratio among the risk factors (4.41 [95% confidence interval, 3.63–5.36]). High odds ratios were also observed in total mastectomy (2.32 [2.10–2.56]), flap reconstruction (1.93 [1.55–2.40]), and preoperative heparin use (1.64 [1.26–2.14]). The results corresponded with the sensitivity analyses.

Conclusions

This study identified several risk factors for postoperative bleeding in breast cancer surgery, such as high body mass index, anemia, cardiovascular diseases, liver diseases, psychoses, preoperative heparin use, and surgical procedures.

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Funding

This work was supported by grants from the Ministry of Health, Labor and Welfare, Japan (21AA2007 and 20AA2005), and the Ministry of Education, Culture, Sports, Science and Technology, Japan (20H03907).

Author information

Authors and Affiliations

  1. Department of Breast and Endocrine Surgery, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan

    Takaaki Konishi, Masahiko Tanabe & Yasuyuki Seto

  2. Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan

    Takaaki Konishi, Michimasa Fujiogi, Daisuke Shigemi, Hiroki Matsui & Hideo Yasunaga

  3. Division of Surgery, National Center for Child Health and Development, Japan of Emergency Medicine, 2-10-1 Okura, Setagaya-ku, Tokyo, 157-0074, Japan

    Michimasa Fujiogi

  4. Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan

    Kiyohide Fushimi

Authors
  1. Takaaki Konishi
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  2. Michimasa Fujiogi
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Corresponding author

Correspondence to Takaaki Konishi.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethics approval

This study was conducted in accordance with the Declaration of Helsinki and approved by the Institutional Review Board at The University of Tokyo [approval number: 3501-(3) (December 25th, 2017)].

Compliance with ethical requirements

The authors declare that they comply with the journal’s ethical policies.

Informed consent

Due to anonymity of the patient database, the requirement for informed consent in the present study was waived.

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Konishi, T., Fujiogi, M., Shigemi, D. et al. Risk Factors for Postoperative Bleeding Following Breast Cancer Surgery: A Nationwide Database Study of 477,108 Cases in Japan. World J Surg 46, 3062–3071 (2022). https://doi.org/10.1007/s00268-022-06746-z

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