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VTE risk higher for older women after autologous breast reconstruction
Age is not associated with risk for complications after implant-based breast reconstruction, but it does serve as an independent risk factor for venous thromboembolism after autologous reconstruction, according to study results.
Breast reconstruction surgery after mastectomy may improve quality of life for patients by boosting self-esteem or helping with body image. However, older patients usually do not undergo the procedure, and previous studies show they are even less likely to receive standard therapy for breast cancer, likely because of an increased chance for morbidity, according to study background.
Mark Sisco, MD, clinical assistant professor in the division of plastic and reconstructive surgery at NorthShore University Health System and the University of Chicago, and colleagues conducted a study that evaluated the effect of age and breast reconstruction after mastectomy on perioperative complications. The researchers hypothesized that the attributable risk of the reconstruction would increase with age, but would still remain small.
The researchers used a database from the American College of Surgeons National Surgery Quality Improvement Program to identify 40,769 patients with breast cancer who underwent a unilateral mastectomy alone or with immediate reconstruction between 2005 and 2012.
Researchers calculated complication rates 30 days for women who underwent implant-based reconstruction, autologous reconstruction or mastectomy alone. They compared complication rates among women aged younger than 65 years with those of women aged 65 years or older.
Slightly more than one-third (37%) of the patients were aged at least 65 years.
Results showed patients aged younger than 65 years were nearly four times as likely to undergo breast reconstruction (39.5% vs. 10.7%).
Attributable risks of reconstruction based on longer hospital stays, frequent complications and reoperations were similar in both the older and younger groups (P < .001), and there were no differences in adjusted complication rates between older and younger patients who underwent implant-based reconstruction.
However, among women who underwent autologous reconstruction, those aged at least 65 years were considerably more likely than younger patients to develop VTE (OR = 3.67; P = .02). Adjusted data showed the risk for VTE was nearly four times higher in women aged at least 65 years, and about six times higher (OR = 6.24; 95% CI, 1.52-25.54) among women aged 70 to 75 years.
The overall rate of VTE after autologous reconstruction was 0.9%; however, it was 2.2% among women aged at least 65 years.
“Older women considering implant-based reconstruction should be assured that their age is not a factor in determining the risk of complications,” Sisco and colleagues wrote. “However, those considering autologous reconstruction should be counseled that their age may confer an increased risk of VTE. Special attention should be paid to the prevention of VTE in this patient population.” – by Anthony SanFilippo
Disclosure: The researchers report no relevant financial disclosures.