De La Cruz Ku Gabriel, Camarlinghi Madison, Mallouh Michael P, Torres-Roman J Smith, Linshaw David, Persing Sarah M, Nardello Salvatore, Chatterjee Abhishek
Department of Surgery, University of Massachusetts Medical School, Worcester, Massachusetts, USA.
Universidad Cientifica del Sur, Lima, Peru.
J Surg Oncol. 2023 Dec;128(7):1052-1063. doi: 10.1002/jso.27397. Epub 2023 Jul 13.
Obesity has nearly tripled in the last 50 years. During the last decades, oncoplastic breast surgery has become an important choice in the surgical treatment of breast cancer. An association exists between higher body mass index (BMI) and wound complications for major operations, but there is scarce literature on oncoplastic surgery. Hence, our aim was to compare the complication rates among patients who underwent oncoplastic surgery, stratified by BMI.
Patient data were analyzed from the National Surgical Quality Improvement Program database (NSQIP) for oncoplastic breast procedures (2005-2020). Patients were stratified according to World Health Organization obesity classifications. Multivariate logistic regression was performed to assess risk factors for complications (overall, operative, and wound-related).
From a total of 6887 patients who underwent oncoplastic surgery, 4229 patients were nonobese, 1380 had Class 1 obesity (BMI: 30 to <35 kg/m ), 737 Class 2 obesity (BMI: 35 to <40 kg/m ), and 541 Class 3 obesity (BMI: ≥ 40 kg/m ). Greater operative time was found according to higher BMI (p < 0.001). Multivariate analysis adjusted for baseline characteristics showed that patients with obesity Class 2 (odds ratio [OR] = 1.51, 95% confidence interval [CI]: 1.03-2.23, p = 0.037) and 3 (OR = 1.87, 95% CI 1.24-2.83, p = 0.003) had increased risk of overall and wound complications compared with Nonobese patients. Comparing obese with nonobese patients, there were no differences in rates of deep SSI, organ/space SSI, pneumonia, reintubation, pulmonary embolism, deep vein thrombosis, urinary tract infection, stroke, bleeding, postoperative sepsis, length of stay, and readmission.
Oncoplastic surgery is a safe procedure for most patients. However, caution should be exercised when performing oncoplastic surgery for patients with Class 2 or 3 obesity (BMI ≥ 35 kg/m ), given there was a higher rate of overall and wound-specific complications, compared with patients who were not obese or had Class 1 obesity.
在过去50年中，肥胖率几乎增长了两倍。在过去几十年里，肿瘤整形乳房手术已成为乳腺癌外科治疗的重要选择。较高的体重指数（BMI）与大手术的伤口并发症之间存在关联，但关于肿瘤整形手术的文献较少。因此，我们的目的是比较接受肿瘤整形手术患者按BMI分层后的并发症发生率。
分析了国家外科质量改进计划数据库（NSQIP）中2005年至2020年肿瘤整形乳房手术的患者数据。根据世界卫生组织的肥胖分类对患者进行分层。进行多因素逻辑回归以评估并发症（总体、手术和伤口相关）的危险因素。
在总共6887例接受肿瘤整形手术的患者中，4229例为非肥胖患者，1380例为1级肥胖（BMI：30至<35kg/m²），737例为2级肥胖（BMI：35至<40kg/m²），541例为3级肥胖（BMI：≥40kg/m²）。根据较高的BMI发现手术时间更长（p<0.001）。对基线特征进行调整后的多因素分析显示，与非肥胖患者相比，2级肥胖（比值比[OR]=1.51，95%置信区间[CI]：1.03-2.23，p=0.037）和3级肥胖（OR=1.87，95%CI 1.24-2.83，p=0.003）患者发生总体和伤口并发症的风险增加。将肥胖患者与非肥胖患者进行比较，深部手术部位感染、器官/腔隙手术部位感染、肺炎、再次插管、肺栓塞、深静脉血栓形成、尿路感染、中风、出血、术后脓毒症、住院时间和再入院率没有差异。
对于大多数患者来说，肿瘤整形手术是一种安全的手术。然而，对于2级或3级肥胖（BMI≥35kg/m²）的患者进行肿瘤整形手术时应谨慎，因为与非肥胖或患有1级肥胖的患者相比，总体和伤口特异性并发症的发生率更高。
