Preoperative anemia and postoperative outcomes in immediate breast reconstructive surgery : a critical analysis of 10,958 patients from the ACS-NSQIP database
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Date
2013-08-06
Journal Title
Journal ISSN
Volume Title
Publisher
Plastic and reconstructive surgery. Global open.
Abstract
Background: Preoperative anemia is independently associated with adverse
outcomes after general and cardiac surgery. Outcomes after breast reconstruction
are not established. We assessed the effect of preoperative anemia
on 30-day postoperative morbidity and length of hospital stay (LOS) in
patients undergoing immediate breast reconstruction.
Methods: We identified patients undergoing immediate breast reconstruction
from 2008 to 2010 from the American College of Surgeons’ National
Surgical Quality Improvement Program database (a prospective outcomesbased
registry from hospitals worldwide). De-identified data were obtained
for demographics, preoperative risk factors, 30-day morbidity, and LOS.
Morbidity variables included flap/graft/prosthesis, cardiac, respiratory,
neurological, urinary, wound, and venous thromboembolism outcomes.
Logistic regression assessed the crude and adjusted effect of anemia (hematocrit
<36%) on postoperative 30-day morbidity. Measures of central
tendency of LOS were compared across increasing severities of anemia in
patients developing adverse events versus controls.
Results: The study population included 10,958 patients; 1556 (16.74%) had
preoperative anemia. Crude odds ratio for 30-day morbidity was significantly
higher in anemic patients, unadjusted odds ratio = 1.33 (P < 0.008). This prevailed
after extensive adjustment for confounding, yielding an adjusted odds
ratio = 1.38 (P < 0.03). Patients who experienced adverse effects had protracted
LOS, and the presence of anemia significantly amplified this effect.
Conclusions: These data provide new insight into the effect of anemia in
immediate breast reconstruction, demonstrating an independent association
between preoperative anemia and 30-day morbidity. These findings
suggest treating anemia when possible; however, prospective studies should
explore the efficacy, safety, and cost-effectiveness of such treatments.
Description
PMID: 25289224
Keywords
American College of Surgeons’ National Surgical Quality Improvement Program database, Immediate Breast Reconstruction, Postoperative Outcomes, Anemia, Postoperative Complications
Citation
doi:10.1097/GOX.0b013e3182a18c6f