An analysis of underweight status on 30-day outcomes after breast reconstruction

Abstract

Aim: To examine the impact of underweight body mass index (BMI) values on breast reconstruction outcomes.

Methods: The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database was retrospectively reviewed for all patients who underwent breast reconstruction between 2006 and 2011. Patients were first stratified by breast reconstruction modality into prosthetic or autologous cohorts, and second by BMI values into underweight (BMI < 18.5), normal to overweight (reference, BMI 18.5-29.99), moderate obesity (BMI 30-34.99), severe obesity (BMI 35-39.99), and morbid obesity cohorts. Multivariate logistic regression models were used to determine independent predictors of complications.

Results: With regard to prosthetic breast reconstruction patients, obese patients demonstrated increased rates of surgical complications, while underweight patients did not have any differences on multivariable analysis. With respect to autologous reconstruction, risk-adjusted multivariate regression models showed a dose dependent response between obesity and risk for surgical complications and reoperation, but not for underweight patients.

Conclusion: On multivariable analysis of over 4,600 patients, there were no significant differences in the rates of adverse events between underweight patients (BMI < 18.5) and their reference-weight counterparts, in spite of a significant increase in surgical and medical complication rates in underweight patients on univariate analysis.

Keywords

Breast reconstruction / underweight / complications / body mass index / obesity

References

[1] World Health Organization..Fact sheet No 311: Obesity and overweight..2012;GenevaWorld Health Organization

[2] Ogden CL,Kit BK.Prevalence of obesity in the United States, 2009-2010..NCHS Data Brief2012;(82):1-8

[3] Russell GV,Nunley L.Financial implications of obesity..Orthop Clin North Am2011;42:123-7

[4] Arterburn,Maciejewski ML Tsevat J..Impact of morbid obesity on medical expenditures in adults..Int J Obes (Lond)2005;29:334-9

[5] Abedi NN,Xenos E,Minion DJ.Gender and 30-day outcome in patients undergoing endovascular aneurysm repair (EVAR): an analysis using the ACS NSQIP dataset..J Vasc Surg2009;50:486-91

[6] Mullen JT,Hutter MM,Henderson WG,Moorman DW.Impact of body mass index on perioperative outcomes in patients undergoing major intra-abdominal cancer surgery..Ann Surg Oncol2008;15:2164-72

[7] Mullen JT,Davenport DL.The obesity paradox: body mass index and outcomes in patients undergoing nonbariatric general surgery..Ann Surg2009;250:166-72

[8] Tremblay A.Impact of body mass index on outcomes following critical care..Chest2003;123:1202-7

[9] O'Brien JMJr,Ali NA,Marsh CB.Body mass index is independently associated with hospital mortality in mechanically ventilated adults with acute lung injury..Crit Care Med2006;34:738-44 PMCID:PMC1868702

[10] Curtis JP,Wang Y,Jovin IS,Kosiborod M,Sokol SI,Krumholz HM.The obesity paradox: body mass index and outcomes in patients with heart failure..Arch Intern Med2005;165:55-61

[11] Galanos AN,Kussin PS,Fulkerson WJ,Teno JM,Connors AFJr,Wenger NS.Relationship of body mass index to subsequent mortality among seriously ill hospitalized patients. SUPPORT Investigators. The Study to Understand Prognoses and Preferences for Outcome and Risks of Treatments..Crit Care Med1997;25:1962-8

[12] Fleischmann E,Dudley J,Bower JD.Influence of excess weight on mortality and hospital stay in 1346 hemodialysis patients..Kidney Int1999;55:1560-7

[13] Fonarow GC,Costanzo MR,Lopatin M.An obesity paradox in acute heart failure: analysis of body mass index and inhospital mortality for 108,927 patients in the Acute Decompensated Heart Failure National Registry..Am Heart J2007;153:74-81

[14] Gruberg L,Waksman R,Deible R,Ahmed LM,Pichard AD,Satler LF.The impact of obesity on the short-term and long-term outcomes after percutaneous coronary intervention: the obesity paradox?.J Am Coll Cardiol2002;39:578-84

[15] Gurm HS,Booth J,Lincoff AM.Impact of body mass index on outcome after percutaneous coronary intervention (the obesity paradox)..Am J Cardiol2002;90:42-5

[16] Christian CK,Edge SB,Hughes ME,Wilson J,Weeks JC.A multi-institutional analysis of the socioeconomic determinants of breast reconstruction: a study of the National Comprehensive Cancer Network..Ann Surg2006;243:241-9 PMCID:PMC1448910

[17] Alderman AK,Kim HM.Complications in postmastectomy breast reconstruction: two-year results of the Michigan Breast Reconstruction Outcome Study..Plast Reconstr Surg2002;109:2265-74

[18] Atisha DM,Kuhn LE.The impact of obesity on patient satisfaction with breast reconstruction..Plast Reconstr Surg2008;121:1893-9

[19] Chapman GWJr,Thompson HE.Morbidity in obese and nonobese patients following gynecologic surgery for cancer..J Natl Med Assoc1988;80:417-20 PMCID:PMC2625755

[20] Foley K.Surgical complications of obese patients with endometrial carcinoma..Gynecol Oncol1990;39:171-4

[21] Jiganti JJ,Williams CS.A comparison of the perioperative morbidity in total joint arthroplasty in the obese and nonobese patient..Clin Orthop Relat Res1993;175-9

[22] Stern SH.Total knee arthroplasty in obese patients..J Bone Joint Surg Am1990;72:1400-4

[23] Vinton AL,Jolly PC.Wound complications after modified radical mastectomy compared with tylectomy with axillary lymph node dissection..Am J Surg1991;161:584-8

[24] Thomas EJ,Mangione CM,Cook EF,Sugarbaker D,Donaldson M.Body mass index as a correlate of postoperative complications and resource utilization..Am J Med1997;102:277-83

[25] Klasen J,Hartmann B.Increased body mass index and peri-operative risk in patients undergoing non-cardiac surgery..Obes Surg2004;14:275-81

[26] Dindo D,Weber M.Obesity in general elective surgery..Lancet2003;361:2032-5

[27] Kim EK,Hwang CH,Son BH.Immediate transverse rectus abdominis musculocutaneous (TRAM) flap breast reconstruction in underweight Asian patients..Breast Cancer2014;21:693-7

[28] Kroll SS.Bilateral breast reconstruction in very thin patients with extended free TRAM flaps..Br J Plast Surg1998;51:535-7

[29] Lee JH,Oh DY,Ahn ST.Subpectoral-subfascial breast augmentation for thin-skinned patients..Aesthetic Plast Surg2012;36:115-21

[30] Kronowitz SJ,Youssef A,Chang SH,Ng RL,Miller MJ.Optimizing autologous breast reconstruction in thin patients..Plast Reconstr Surg2003;112:1768-78

[31] Figus A,Ramakrishnan V.Stacked free SIEA/DIEP flap for unilateral breast reconstruction in a thin patient with an abdominal vertical midline scar..J Reconstr Microsurg2007;23:523-5

[32] Kitcat M,Meldon C,Clibbon J.A Simple Algorithm for Immediate Postmastectomy Reconstruction of the Small Breast-A Single Surgeon's 10-Year Experience..Eplasty2012;12:e55 PMCID:PMC3521473

[33] Albornoz CR,Farias-Eisner G,Pusic AL,Disa JJ,Matros E.Diminishing relative contraindications for immediate breast reconstruction..Plast Reconstr Surg2014;134:e363-9

[34] Nguyen KT,Smetona JT,Seth AK.Body mass index as a continuous predictor of outcomes after expander-implant breast reconstruction..Ann Plast Surg2014;73:19-24