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Does oncoplastic surgery increase immediate (30-day) postoperative complications? An analysis of the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database

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

Abstract

Purpose

Although there has been a significant increase in the use of oncoplastic surgery (OPS), data on the postoperative safety of this approach are limited compared to traditional lumpectomy. This study aimed to compare the immediate (30-day) postoperative complications associated with OPS and traditional lumpectomy.

Methods

An analysis of the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database was performed on women with breast cancer who underwent OPS or traditional lumpectomy. Logistic regression was used to explore the effect of type of surgery on the outcome of interest.

Results

A total of 109,487 women were analyzed of whom 8.3% underwent OPS. OPS had a longer median operative time than traditional lumpectomy. The unadjusted immediate (30-day) overall complication rate was significantly higher with OPS than traditional lumpectomy (3.8% versus 2.6%, p < 0.001). After adjusting for baseline differences, overall 30-day postoperative complications were significantly higher amongst women undergoing OPS compared with traditional lumpectomy (OR 1.41, 95%CI 1.24–1.59). Factors that were independent predictors of overall 30-day complications included higher age, higher BMI, race, smoking status, lymph node surgery, neoadjuvant chemotherapy, ASA class ≥ 3, in situ disease, and year of operation. The interaction term between type of surgery and operative time was not statistically significant, indicating that operative time did not modify the effect of type of surgery on immediate postoperative complications.

Conclusions

Although there were slightly higher overall complication rates with OPS, the absolute rates remained quite low for both groups. Therefore, OPS may be performed in women with breast cancer who are suitable candidates.

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Abbreviations

ACS NSQIP:

American College of Surgeons National Surgical Quality Improvement Program

ASA:

American Society of Anesthesiology

ALND:

Axillary lymph node dissection

CHF:

Congestive heart failure

COPD:

Chronic obstructive pulmonary disease

CPT:

Current procedural terminology

ICD-9:

International Classification of Diseases Ninth Revision

OPS:

Oncoplastic surgery

PCI:

Percutaneous coronary intervention

PUF:

Participant user data file

SLNB:

Sentinel lymph node biopsy

TIA:

Transient ischemic attack

UTI:

Urinary tract infection

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Funding

This research did not receive any grant from funding agencies in the public, commercial, or not-for-profit sectors.

Author information

Authors and Affiliations

  1. Division of General Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada

    Fernando A. Angarita, Sergio A. Acuna, David R. McCready & Tulin D. Cil

  2. Division of General Surgery, The Ottawa Hospital, Ottawa, ON, Canada

    Erin Cordeiro

  3. Department of Surgical Oncology, Princess Margaret Cancer Centre, Toronto, ON, Canada

    David R. McCready & Tulin D. Cil

  4. Department of Surgery, Women’s College Hospital, Toronto, ON, Canada

    Tulin D. Cil

  5. Division of General Surgery, University Health Network, 610 University Ave, OPG- 6th floor, Toronto, ON, M5G 2M9, Canada

    Tulin D. Cil

Authors
  1. Fernando A. Angarita
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  2. Sergio A. Acuna
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  3. Erin Cordeiro
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  4. David R. McCready
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  5. Tulin D. Cil
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Corresponding author

Correspondence to Tulin D. Cil.

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Conflict of interest

FAA declares that he has no conflict of interest. SAA declares that he has no conflict of interest. EC declares that she has no conflict of interest. DRM declares that he has no conflict of interest. TC declares that she has no conflict of interest.

Ethical approval

 The Ethics Review Board has deemed this retrospective review of de-identified data exempt from institutional review. De-identified patient information is freely available to all institutional members who comply with the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) data use agreement.

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Angarita, F.A., Acuna, S.A., Cordeiro, E. et al. Does oncoplastic surgery increase immediate (30-day) postoperative complications? An analysis of the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database. Breast Cancer Res Treat 182, 429–438 (2020). https://doi.org/10.1007/s10549-020-05665-8

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  • DOI: https://doi.org/10.1007/s10549-020-05665-8

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