Nguyen Khang T, Hanwright Philip J, Smetona John T, Hirsch Elliot M, Seth Akhil K, Kim John Y S
From the *Division of Plastic and Reconstructive Surgery, Feinberg School of Medicine, Northwestern University; and †Northwestern Memorial Hospital, Chicago, IL.
Ann Plast Surg. 2014 Jul;73(1):19-24. doi: 10.1097/SAP.0b013e318276d91d.
Studies show that obesity is a risk factor for complications after expander/implant breast reconstructions. However, reports vary on the precise threshold of body mass index (BMI) as a predictor of heightened risk. We endeavored to link BMI as a continuous variable to overall complications in a single-surgeon series of expander-implant reconstructions.
From 399 patients undergoing expander-implant reconstruction, 551 breasts were stratified to normal weight, overweight, and obese groups for analysis and comparison with previous studies. Logistic regression was performed to predict changes to risk profile per increment of BMI.
Complication rates for obese and overweight patients were significantly greater than for normal weight patients, that is, 21.1% and 24.0% versus 10.4%, respectively (P < 0.005). A unit increase in BMI predicted a 5.9% increase in the odds of a complication occurring, and 7.9% increase in the odds of reconstruction ending in failure.
By expanding the analysis of BMI to include patients who do not meet the traditional definition of obesity (BMI ≥ 30 kg/m), we demonstrated that simply overweight patients (25 ≤ BMI < 30 kg/m) had an elevated complication rate. Moreover, through regression analysis, we established that BMI as a continuous variable predicts outcomes from expander-based breast reconstruction.
研究表明，肥胖是扩张器/植入物乳房重建术后并发症的一个风险因素。然而，关于体重指数（BMI）作为风险增加预测指标的确切阈值，报告各不相同。我们试图在一组由单一外科医生进行的扩张器-植入物重建手术中，将BMI作为一个连续变量与总体并发症联系起来。
从399例行扩张器-植入物重建手术的患者中，选取551侧乳房分为正常体重、超重和肥胖组进行分析，并与之前的研究进行比较。采用逻辑回归分析来预测BMI每增加一个单位时风险状况的变化。
肥胖和超重患者的并发症发生率显著高于正常体重患者，分别为21.1%和24.0%，而正常体重患者为10.4%（P<0.005）。BMI每增加一个单位，并发症发生几率增加5.9%，重建失败几率增加7.9%。
通过将BMI分析范围扩大至未达到传统肥胖定义（BMI≥30kg/m²）的患者，我们证明单纯超重患者（25≤BMI<30kg/m²）的并发症发生率也会升高。此外，通过回归分析，我们确定BMI作为一个连续变量可预测基于扩张器的乳房重建结果。
