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The impact of obesity on outcomes for patients undergoing mastectomy using the ACS-NSQIP data set

  • Epidemiology
  • Published:
Breast Cancer Research and Treatment Aims and scope Submit manuscript

Abstract

Purpose

According to the World Health Organization (WHO), 34.7% of females in the United States are obese (BMI ≥ 30) in 2014, compared to 32.5% in 2010. The previous research has demonstrated high BMI as an independent risk factor for surgical complications after breast surgery. As more patients become obese, we sought to examine whether increasing obesity had an effect on outcomes of women who underwent a unilateral mastectomy without breast reconstruction.

Methods

The study reviewed the 2007–2012 ACS-NSQIP database and identified all patients who underwent a unilateral mastectomy without reconstruction. Patients were then categorized and compared according to the World Health Organization obesity classification. Data were analyzed for minor complications (e.g., UTI and SSI) and major complications (e.g., renal failure, sepsis, deep vein thrombosis, return to operating room [RTOR], and cardiac arrest).

Results

A total of 7207 women were identified. Median BMI was 27.3 kg/m2. From the cohort, 453 patients (6.29%) had a major complication and 173 patients (2.40%) had a minor complication. 53 (0.74%) had bleeding complications, 148 (2.05%) had a surgical site infection (SSI), 352 (4.88%) RTOR, and 7 (0.01%) died within 30 days. Major complications (p = 0.005) and minor complications (p < 0.001) significantly increased as BMI increased. SSI and RTOR had increasing trends, but were not statistically significant.

Conclusions

This study characterizes the risk of complications in women undergoing unilateral mastectomies and shows that increasing obesity is associated with major and minor postoperative complications. Our finding highlights the need for personalized preoperative risk assessment and counseling of obese patients.

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References

  1. WHO (World Health Organization). Prevalence of obesity. http://gamapserver.who.int/gho/interactive_charts/ncd/risk_factors/obesity/atlas.html. Accessed 24 May 2017

  2. Sun SX, Greenleaf EK, Hollenbeak CS, Leung AM (2015) Attributable cost of obesity in breast surgery: a matched cohort analysis. Am J Surg 210:668.e1–677.e1. https://doi.org/10.1016/j.amjsurg.2015.06.003

    Google Scholar 

  3. Chow I, Hanwright PJ, Hansen NM, Leilabadi SN, Kim JYS (2015) Predictors of 30-day readmission after mastectomy: a multi-institutional analysis of 21,271 patients. Breast Dis 35:221–231. https://doi.org/10.3233/BD-150412

    Article  PubMed  Google Scholar 

  4. de Blacam C, Ogunleye AA, Momoh AO, Colakoglu S, Tobias AM, Sharma R, Houlihan MJ, Lee BT (2012) High body mass index and smoking predict morbidity in breast cancer surgery. Ann Surg 255:551–555. https://doi.org/10.1097/SLA.0b013e318246c294

    Article  PubMed  Google Scholar 

  5. Olsen MA, Lefta M, Dietz JR, Brandt KE, Aft R, Matthews R, Mayfield J, Fraser VJ (2008) Risk factors for surgical site infection after major breast operation. J Am Coll Surg 207:326–335. https://doi.org/10.1016/j.jamcollsurg.2008.04.021

    Article  PubMed  PubMed Central  Google Scholar 

  6. Fischer JP, Tuggle CT, Au A, Kovach SJ (2014) A 30-day risk assessment of mastectomy alone compared to immediate breast reconstruction (IBR). J Plast Surg Hand Surg 48:209–215. https://doi.org/10.3109/2000656X.2013.865633

    Article  PubMed  Google Scholar 

  7. Fischer JP, Nelson JA, Kovach SJ, Serletti JM, Wu LC, Kanchwala S (2013) Impact of obesity on outcomes in breast reconstruction: analysis of 15,937 patients from the ACS-NSQIP datasets. J Am Coll Surg 217:656–664. https://doi.org/10.1016/j.jamcollsurg.2013.03.031

    Article  PubMed  Google Scholar 

  8. Osman F, Saleh F, Jackson TD, Corrigan MA, Cil T (2013) Increased postoperative complications in bilateral mastectomy patients compared to unilateral mastectomy: an analysis of the NSQIP database. Ann Surg Oncol 20:3212–3217. https://doi.org/10.1245/s10434-013-3116-1

    Article  PubMed  Google Scholar 

  9. Mortenson MM, Schneider PD, Khatri VP, Stevenson TR, Whetzel TP, Sommerhaug EJ, Goodnight JE Jr, Bold RJ (2004) Immediate breast reconstruction after mastectomy increases wound complications. Arch Surg 139:988. https://doi.org/10.1001/archsurg.139.9.988

    Article  PubMed  Google Scholar 

  10. McCarthy CM, Mehrara BJ, Riedel E, Davidge K, Hinson A, Disa JJ, Cordeiro PG, Pusic AL (2008) Predicting complications following expander/implant breast reconstruction: an outcomes analysis based on preoperative clinical risk. Plast Reconstr Surg 121:1886–1892. https://doi.org/10.1097/PRS.0b013e31817151c4

    Article  CAS  PubMed  Google Scholar 

  11. WHO (2013) Physical status: the use and interpretation of anthropometry. WHO, Geneva

    Google Scholar 

  12. Ata A, Lee J, Bestle SL, Desemone J, Stain SC (2010) Postoperative hyperglycemia and surgical site infection in general surgery patients. Arch Surg 145:858. https://doi.org/10.1001/archsurg.2010.179

    Article  PubMed  Google Scholar 

  13. Sørensen LT, Hørby J, Friis E, Pilsgaard B, Jørgensen T, Meguid M (2002) Smoking as a risk factor for wound healing and infection in breast cancer surgery. Eur J Surg Oncol 28:815–820. https://doi.org/10.1053/EJSO.2002.1308

    Article  PubMed  Google Scholar 

  14. Jain RK (2001) Clearing the smoke on nicotine and angiogenesis. Nat Med 7:775–777. https://doi.org/10.1038/89889

    Article  CAS  PubMed  Google Scholar 

  15. Mokdad AH, Ford ES, Bowman BA, Dietz WH, Vinicor F, Bales VS, Marks JS (2003) Prevalence of obesity, diabetes, and obesity-related health risk factors, 2001. JAMA 289:393–403. https://doi.org/10.1001/jama.289.1.76

    Article  Google Scholar 

  16. Haakinson DJ, Leeds SG, Dueck AC, Gray RJ, Wasif N, Stucky C-CH, Northfelt DW, Apsey HA, Pockaj B (2012) The impact of obesity on breast cancer: a retrospective review. Ann Surg Oncol 19:3012–3018. https://doi.org/10.1245/s10434-012-2320-8

    Article  PubMed  Google Scholar 

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Acknowledgements

This work is partially supported by the Cancer Center Support Grant from the National Cancer Institute to the Comprehensive Cancer Center of Wake Forest Baptist Medical Center (P30 CA012197).

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Authors and Affiliations

  1. Department of Surgical Oncology, Wake Forest School of Medicine, Medical Center Blvd, Winston-Salem, NC, 27157, USA

    Mary Garland, Clancy Clark, Akiko Chiba & Marissa Howard-McNatt

  2. Department of Biostatistics, Wake Forest School of Medicine, Medical Center Blvd, Winston-Salem, NC, USA

    Fang-Chi Hsu

  3. Wake Forest Baptist Comprehensive Cancer Center, Medical Center Blvd, Winston-Salem, NC, USA

    Mary Garland, Fang-Chi Hsu, Clancy Clark, Akiko Chiba & Marissa Howard-McNatt

Authors
  1. Mary Garland
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  2. Fang-Chi Hsu
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Correspondence to Mary Garland.

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All authors declare that they have no conflict of interest.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Retrospective review of de-identified patients using the NSQIP database.

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Garland, M., Hsu, FC., Clark, C. et al. The impact of obesity on outcomes for patients undergoing mastectomy using the ACS-NSQIP data set. Breast Cancer Res Treat 168, 723–726 (2018). https://doi.org/10.1007/s10549-017-4651-4

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  • DOI: https://doi.org/10.1007/s10549-017-4651-4

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