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Immediate breast reconstruction has higher complication rates vs. delayed in patients with diabetes
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Patients with diabetes who underwent immediate breast reconstruction following mastectomy had significantly higher rates for complications compared with delayed reconstruction, according to study results published in Plastic Reconstructive Surgery Global Open.
Researchers reviewed patient data from the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) between Jan. 1, 2005 and Dec. 31, 2012, and from The John Hopkins Hospital (JHH) experience.
The NSQIP cohort included 1,408 patients, of which 958 (68%) received immediate reconstruction and 450 (32%) received delayed reconstruction.
The immediate group had significantly higher reconstruction failure rates than the delayed group (1.57% vs. 0.22%; P = .027), and higher rates of overall morbidity (10.75% vs. 7.78%; P = .080) and surgical morbidity (10.02% vs. 6.89%; P = .056). The delayed group, however, had a significantly higher rate of acute renal failure (0% vs. 0.44%; P = .039).
The JHH cohort included 52 patients. Thirty-nine patients underwent 59 immediate reconstructions (19 unilateral and 20 bilateral) and 36 patients underwent 55 delayed reconstructions (17 unilateral and 19 bilateral).
At 30-days follow-up, the immediate group had significantly higher reconstruction failure rates than the delayed group (12.8% vs. 0%; P = .028). On long-term follow-up (range, 0.5-150 months), the rates of reconstruction failure (25.6% vs. 0%; P = .001) and reoperation (30.8% vs. 2.8%; P = .001) were also significantly higher for the immediate group. Overall and surgical morbidity rates did not significantly differ between the two groups at either 30 or 60 days follow up.
“Our analysis of diabetic females in the NSQIP undergoing breast reconstruction demonstrates that those who undergo an immediate reconstruction have significantly higher odds of developing 30-day overall and surgical complications compared with those undergoing delayed reconstruction,” the researchers wrote. “Given [the] known hematological and vascular abnormalities, optimizing the surgical course of diabetic patients is especially important.” – by Talitha Bennett
Disclosure: The researchers report no relevant financial disclosures.
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