Breast
Ali Esparham, Medical Student
Medical Student
Student Research Committee, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran, United States
Armaan Ahmed
Undergraduate Student
Johns Hopkins University
Larchmont, New York, United States
Armaan Ahmed
Undergraduate Student
Johns Hopkins University
Larchmont, New York, United States
Saeed Shoar, MD, MPH
Clinical Research Scientist
Department of Clinical Research, Scientific Collaborative Initiative, Houston/Largo, TX/MD, United States
Zahra Shafaee, MD, MBA, FSSO, FACS (she/her/hers)
Attending Surgeon and Assistant Professor of Surgery
Elmhurst Hospital, NYC Health + Hospitals, New York, NY, USA, Department of Surgery, Icahn School of Medicine, New York, NY, USA
Larchmont, New York, United States
Zahra Shafaee, MD, MBA, FSSO, FACS (she/her/hers)
Attending Surgeon and Assistant Professor of Surgery
Elmhurst Hospital, NYC Health + Hospitals, New York, NY, USA, Department of Surgery, Icahn School of Medicine, New York, NY, USA
Larchmont, New York, United States
Breast reconstruction after mastectomy enhances patients' quality of life. Our study compares immediate implant-based (IBR) and autologous-based (ABR) reconstruction outcomes and their prevalences.
Methods:
We conducted an analysis of the National Inpatient Sample (NIS) data between 2016 and 2020. We used propensity score matching (PSM) to match ABR and IBR groups in a 1:1 ratio on age, race, primary expected payer, household income, hospital bed size, and hospital teaching status. Weighted analysis was performed using NIS-provided weights in SPSS (version 27). Multivariate logistic regression was used, with adjustments made for baseline characteristics. p< 0.05 was used as the significance threshold.
Results:
The IBR and ABR groups consist of 25420 and 13375 patients, respectively. There was a significantly higher proportion of white patients in the IBR compared to the ABR group (73.9% vs 67.6%) and a significantly lower proportion of black and Hispanic patients in the IBR compared to the ABR group (9.4% vs 12.1% and 9.3% vs 12.5%, respectively). After PSM, 13370 patients were included in each group. ABR was independently associated with a higher risk of post-procedure anemia (odds ratio [OR]: 5.24, 95% confidence interval [CI]: 4.68-5.87), blood transfusion (OR: 3.71, 95% CI: 3.12-4.41), deep vein thrombosis/pulmonary thromboembolism (OR: 1.286, 95% CI: 1.072-1.543), acute kidney injury (OR: 1.75, 95% CI 1.23-2.48), cardiovascular complications (OR: 1.39, 95% CI: 1.17-1.66), mechanical ventilation (OR: 1.59, 95% CI: 1.09-2.32), and vasopressor use (OR: 1.48, 95% CI: 1.13-1.94). On the other hand, ABR was independently associated with a lower risk of reconstruction complications, including implant complication, graft, or flap failure (OR: 0.540, 95% CI: 0.499-0.585), sepsis (OR: 0.253, 95% CI: 0.179-0.359), and wound dehiscence (OR: 0.183, 95% CI: 0.124-0.271). ABR was associated with a significantly longer hospital stay (3.77±1.91 days vs 1.87±1.46 days) and higher cost ($34,442 ± $19,586 vs $22,365 ±$11,644) compared to IBR. Notably, there was no in-hospital mortality. Additionally, the proportion of ABR procedures significantly increased while the proportion of IBR procedures significantly decreased from 2016 to 2022 (p< 0.01) (Figure 1).
Conclusions:
As the proportion of ABR procedures is increasing, it is important to consider postoperative complications, higher hospitalization costs, and longer lengths of stay.