Yu Victor J, Pham Jason T, Evans Adam G, Guo Yifan
Division of Plastic and Reconstructive Surgery, Eastern Virginia Medical School, 301 Riverview Avenue, Norfolk, VA, USA.
Aesthetic Plast Surg. 2024 Dec;48(23):4922-4929. doi: 10.1007/s00266-024-04048-4. Epub 2024 May 8.
Macromastia is a physically and psychologically distressing condition for adolescents. While reduction mammaplasty is often the best treatment, risk factors for adolescent wound complications remain unclear. This study aims to investigate the impact of obesity and other predictors of postoperative wound complications following adolescent reduction mammaplasty using a national database.
The 2012-2019 National Surgical Quality Improvement Program Pediatric (NSQIP-P) databases were reviewed to identify primary reduction mammaplasty encounters. World Health Organization Body Mass Index (BMI), alongside patient and case characteristics, were assessed for association for 30-day wound disruption or surgical site complications. Statistical analyses were performed to identify independent predictors for complications and determine a potential BMI cutoff for risk stratification.
There were 1215 patients with an average age of 16.6 years. The average BMI was 30.7 kg/m, and 593 (48.8%) patients were nonobese while 622 (51.2%) were obese. The incidence of complications was 5.27%. Independent predictors of complications included a BMI 35-39.9, BMI > 40, and an American Society of Anesthesiologists (ASA) Classification > 3. A receiver operating characteristic curve determined that a BMI of 34.6 can be a potential cutoff for increased complication risk.
Higher obesity increases risk of wound complications; however, complication rates remain low. A BMI of 34.6 is a potential screening metric for counseling and monitoring patients. Reduction mammaplasty should remain a viable option as it can significantly improve quality of life.
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巨乳症对青少年来说是一种身心痛苦的疾病。虽然乳房缩小成形术通常是最佳治疗方法，但青少年伤口并发症的风险因素仍不明确。本研究旨在利用国家数据库调查肥胖及其他因素对青少年乳房缩小成形术后伤口并发症的影响。
回顾2012 - 2019年国家外科质量改进计划儿科（NSQIP - P）数据库，以确定初次乳房缩小成形术病例。评估世界卫生组织身体质量指数（BMI）以及患者和病例特征与30天伤口裂开或手术部位并发症之间的关联。进行统计分析以确定并发症的独立预测因素，并确定风险分层的潜在BMI临界值。
共有1215例患者，平均年龄16.6岁。平均BMI为30.7kg/m²，593例（48.8%）患者非肥胖，622例（51.2%）患者肥胖。并发症发生率为5.27%。并发症的独立预测因素包括BMI为35 - 39.9、BMI＞40以及美国麻醉医师协会（ASA）分级＞3。受试者工作特征曲线确定BMI为34.6可能是并发症风险增加的潜在临界值。
肥胖程度越高，伤口并发症风险越高；然而，并发症发生率仍然较低。BMI为34.6是咨询和监测患者的潜在筛查指标。乳房缩小成形术仍应是一个可行的选择，因为它可以显著改善生活质量。
证据级别III：本刊要求作者为每篇文章指定证据级别。有关这些循证医学评级的完整描述，请参阅目录或作者在线指南www.springer.com/00266 。
