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Postoperative Outcomes After Staged Versus Coordinated Breast Surgery and Bilateral Salpingo-Oophorectomy

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

The objective of this study was to compare postoperative complication rates and healthcare charges between patients who underwent coordinated versus staged breast surgery and bilateral salpingo-oophorectomy (BSO).

Patients and Methods

The MarketScan administrative database was used to identify adult female patients with invasive breast cancer or BRCA1/BRCA2 mutations who underwent BSO and breast surgery (lumpectomy or mastectomy with or without reconstruction) between 2010 and 2015. Patients were assigned to the coordinated group if a breast operation and BSO were performed simultaneously or assigned to the staged group if BSO was performed separately. Primary outcomes were (1) incidence of 90-day postoperative complications and (2) 2-year aggregate perioperative healthcare charges. Fisher’s exact tests, Wilcoxon rank-sum tests, and multivariable regression analyses were performed.

Results

Of the 4228 patients who underwent breast surgery and BSO, 412 (9.7%) were in the coordinated group and 3816 (90.3%) were in the staged group. The coordinated group had a higher incidence of postoperative complications (24.0% vs. 17.7%, p < 0.01), higher risk-adjusted odds of postoperative complications [odds ratio (OR) 1.37, 95% confidence interval (CI) 1.06–1.76, p = 0.02], and similar aggregate healthcare charges before (median charges: $106,500 vs. $101,555, p = 0.96) and after risk-adjustment [incidence rate ratio (IRR) 1.00, 95% CI 0.93–1.07; p = 0.95]. In a subgroup analysis, incidence of postoperative complications (12.9% for coordinated operations vs. 11.7% for staged operation, p = 0.73) was similar in patients whose breast operation was a lumpectomy.

Conclusions

While costs were similar, coordinating breast surgery with BSO was associated with more complications in patients who underwent mastectomy, but not in patients who underwent lumpectomy. These data should inform shared decision-making in high-risk patients.

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Acknowledgements

This research was supported in part by the Shared Resource of the Colorado Cancer Center support Grant P30CA046934 and University of Colorado Department of Surgery Academic Enrichment Fund seed grant. Further support for this work was provided by Grant 2020141 from the Doris Duke Charitable Foundation and University of Colorado School of Medicine and the Paul Calabresi Clinical Scholars Award.

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Authors and Affiliations

  1. Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO, USA

    Sudheer R. Vemuru MD, Victoria D. Huynh MD, Gretchen Ahrendt MD, Christodoulos Kaoutzanis MD, Simon Kim MD, MPH & Sarah E. Tevis MD

  2. University of Colorado School of Medicine, Surgical Outcomes and Applied Research (SOAR) Program and Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), Aurora, CO, USA

    Michael Bronsert PhD

  3. University of Colorado School of Medicine, Aurora, CO, USA

    Kristen Vossler BS

  4. School of Public Health Department of Biostatistics and Informatics, University of Colorado, Aurora, CO, USA

    Laurel Beaty MS

  5. Department of Obstetrics and Gynecology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA

    Jaime Arruda MD

  6. Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA

    Kristin E. Rojas MD

  7. Department of Surgery, University of Wisconsin School of Medicine, Madison, WI, USA

    Laura Bozzuto MD

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  1. Sudheer R. Vemuru MD
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Contributions

The authors confirm contribution to the paper as follows: study conception and design performed by SV, KV, VH, GA, JA, CK, KR, SK, and ST, data collection performed by SV, MB, VH, and ST, analysis and interpretation of results performed by SV, MB, KV, VH, LB, and ST, and draft manuscript preparation and critical revision performed by SV, MB, KV, VH, LB, GA, JA, CK, KR, LB, SK, and ST All authors reviewed the results and approved the final version of the manuscript.

Corresponding author

Correspondence to Sarah E. Tevis MD.

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Disclosures

Research was presented at American Society of Breast Surgeons Annual Meeting in Las Vegas, NV on 6–10 April 2022. The authors report no proprietary or commercial interest in any product mentioned or concept discussed in this article.

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American Society of Breast Surgeons Annual Meeting, Las Vegas, NV, April 6-10, 2022.

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Vemuru, S.R., Bronsert, M., Vossler, K. et al. Postoperative Outcomes After Staged Versus Coordinated Breast Surgery and Bilateral Salpingo-Oophorectomy. Ann Surg Oncol 30, 5667–5680 (2023). https://doi.org/10.1245/s10434-023-13630-0

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