The Impact of Diabetes on Mastectomy and Breast Reconstruction Outcomes: An Analysis of 106,210 Patients
William J. Rifkin, BA, Rami S. Kantar, MD, Michael J. Cammarata, BS, Joshua A. David, BS, Stelios C. Wilson, MD, J. Rodrigo Diaz-Siso, MD, Alyssa R. Golas, MD, Jamie P. Levine, MD, Daniel J. Ceradini, MD.
Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, NY, USA.
PURPOSE: Wound complications following mastectomy and/or reconstruction may result in longer hospitalization, additional procedures, delayed adjuvant treatment, and suboptimal outcomes. The purpose of this study was to evaluate the impact of diabetes on mastectomy and breast reconstruction surgical outcomes.
METHODS: The ACS-NSQIP database was reviewed from 2010-2015 to identify patients undergoing total, partial, or subcutaneous mastectomy, and immediate or delayed prosthetic reconstruction. Primary outcomes included wound complications and prosthesis failure. Preoperative variables and outcomes were compared between diabetic and non-diabetic patients. Multivariate regression was used to control for confounders.
RESULTS: The following groups were identified: partial (n=52,583), total (n=41,540), subcutaneous mastectomy (n=3,145), immediate (n=4,663) and delayed (n=4,279) prosthetic reconstruction.
Diabetes was associated with significantly increased rates of superficial incisional surgical site infection (SSI) (OR=8.66; p=0.03) in partial mastectomy, deep incisional SSI (OR=1.61; p=0.01) in subcutaneous mastectomy, and both superficial (OR=1.56; p=0.04) and deep incisional SSI (OR=2.07; p=0.04) in total mastectomy.
Diabetes was not associated with any wound complications in immediate reconstruction, but was associated with significantly higher rates of superficial incisional SSI (OR=17.46; p<0.001) in the delayed reconstruction group. There was no association with prosthesis failure in either group.
CONCLUSIONS: This study evaluated the largest national cohort of mastectomy and prosthetic reconstructive procedures, and suggests that diabetic patients are at significantly increased risk of postoperative infectious wound complications, but have no difference in rates of prosthesis failure. These findings highlight the critical need for heightened clinical vigilance and wound care in the diabetic patient population following mastectomy and implant reconstruction.
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