Department of Surgery, Mayo Clinic, Rochester, MN.
Department of Health Sciences Research, Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN.
Surgery. 2019 Oct;166(4):709-714. doi: 10.1016/j.surg.2019.05.055. Epub 2019 Aug 5.
Immediate breast reconstruction after mastectomy may confer more complication rates in the elderly. Therefore, granular analysis of postmastectomy complications in women aged ≥65 years may help formulate clinical guidelines to improve patient selection and outcomes.
We identified patients undergoing mastectomy with or without immediate reconstruction from our breast surgery database (2014-2018). Complications requiring treatment were compared between patients aged ≥65 and <65 years.
A total of 1,721 mastectomies were performed in 1,698 patients; 85.8% had a 30-day follow-up. Of these patients, 968 (65.6%) had immediate breast reconstruction, of whom 95 (9.8%) were aged ≥65 years. Among patients aged ≥65 years, 27.6% underwent mastectomy with immediate breast reconstruction compared with 77.1% of women aged <65 years (P < .001). Overall complication rates were not greater for older compared with younger mastectomy patients but were for older versus younger patients who had mastectomy with immediate breast reconstruction (12.6% vs 6.8%; P = .04). Hematoma requiring reoperation was more frequent in patients aged ≥65 years (5.3% vs 0.9%; P = .006). Necrosis (5.3% vs 2.6%; P = .18) and 30-day unplanned readmissions (7.4% vs 4.0%; P = .18) were not greater.
Despite low overall postoperative complication rates, we found some clinically relevant differences between older and younger patients after mastectomy with immediate breast reconstruction. Additional investigation of contributing factors may help further refine patient selection. In the interim, elderly patients should be counseled on their somewhat greater risk of postoperative complications to facilitate shared decision making.
乳房切除术 后即刻乳房重建可能会增加老年患者的并发症发生率。因此，对≥65 岁女性乳房切除术后并发症进行详细分析，有助于制定临床指南，以改善患者选择和预后。
我们从我院乳腺外科数据库中（2014-2018 年）确定了接受乳房切除术和/或即刻重建的患者。比较了年龄≥65 岁和<65 岁患者的并发症。
共对 1698 例 1721 例患者进行了乳房切除术，85.8%的患者术后 30 天进行了随访。其中 968 例（65.6%）接受了即刻乳房重建，其中 95 例（9.8%）年龄≥65 岁。≥65 岁的患者中，27.6%的患者行乳房切除术即刻乳房重建，而<65 岁的患者中这一比例为 77.1%（P<0.001）。年龄较大的乳房切除术患者的总体并发症发生率并不高于年龄较小的患者，但年龄较大的即刻乳房重建患者的并发症发生率高于年龄较小的患者（12.6%比 6.8%；P=0.04）。年龄较大的患者血肿需再次手术的比例更高（5.3%比 0.9%；P=0.006）。坏死（5.3%比 2.6%；P=0.18）和 30 天计划外再入院（7.4%比 4.0%；P=0.18）并无显著差异。
尽管术后总体并发症发生率较低，但我们发现即刻乳房重建的老年和年轻患者之间存在一些临床相关差异。进一步研究这些差异的相关因素可能有助于进一步优化患者选择。在此期间，应向老年患者告知其术后并发症的风险略高，以促进共同决策。
