Zona Emily E, Orgun Doruk, Bay Caroline C, George Robert E, Thornton Sarah M, Carbullido M Kristine, Dingle Aaron M, Poore Samuel O
From the Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI.
Ann Plast Surg. 2025 Aug 1;95(2):188-195. doi: 10.1097/SAP.0000000000004369. Epub 2025 Apr 28.
Hemoglobin A 1c (HbA 1c ) and body mass index (BMI) are routinely evaluated before both alloplastic and autologous breast reconstruction to assess postoperative complication risk. However, evidence-based guidelines regarding accepted cutoffs for these measures are limited. This study aimed to elucidate the associations between HbA 1c levels or BMI with wound complications following reconstructive breast surgery.
This retrospective cohort study utilized the American College of Surgeons National Surgical Quality Improvement Program database to assess 30-day wound complications among patients who underwent autologous or alloplastic breast reconstruction after mastectomy for breast cancer between January 1, 2021, and December 31, 2022. Wound complications included wound dehiscence, superficial incisional surgical site infections (SSIs), deep incisional SSI, or organ space SSI. Statistical analyses including multivariable Cox regression and Kaplan-Meier curve comparisons were performed based on the distribution of HbA 1c or BMI in the cohort.
A total of 2809 patients underwent breast reconstruction with preoperative HbA 1c measurements. Among these, 2025 (72.1%) underwent alloplastic reconstruction, whereas 784 (27.9%) underwent autologous reconstruction. For the entire cohort, the median age was 54 years, the median HbA 1c was 5.7 (interquartile range, 5.3-6.4), and the median BMI was 29.4 kg/m 2 (interquartile range, 25.5-33.9). The 30-day complication rates in the autologous and alloplastic groups were 11.7% and 7.5%, respectively. Kaplan-Meier curves for the comparison of absolute risk of 30-day wound complications showed no significant differences between HbA 1c quartile curves (log-rank P = 0.46). For BMI, compared with the first quartile, the third (median BMI, 31.5 kg/m 2 ) and fourth quartiles (median BMI, 37.3 kg/m 2 ) had more than double the complication rates (Q1: 5.0%, Q2: 7.3%, Q3: 11.1%, Q4: 11.4%; P < 0.001). Adjusted hazard ratios for 30-day complication risk were 1.83 (95% confidence interval, 1.21-2.77; P = 0.004) for the third BMI quartile and 1.80 (95% confidence interval, 1.18-2.76; P = 0.007) for the fourth.
This study demonstrates that higher BMI is associated with wound complications after breast reconstruction. With the first BMI quartile as reference, patients in BMI quartile 4 had a 75% increased risk of complications in the alloplastic group, whereas the risk increased more than 1.4-fold in the autologous group. No similar associations were observed with HbA 1c levels.
在进行异体和自体乳房重建术前，通常会评估糖化血红蛋白（HbA1c）和体重指数（BMI），以评估术后并发症风险。然而，关于这些指标公认临界值的循证指南有限。本研究旨在阐明HbA1c水平或BMI与乳房重建术后伤口并发症之间的关联。
这项回顾性队列研究利用美国外科医师学会国家外科质量改进计划数据库，评估2021年1月1日至2022年12月31日期间因乳腺癌行乳房切除术后接受自体或异体乳房重建患者的30天伤口并发症情况。伤口并发症包括伤口裂开、浅表切口手术部位感染（SSI）、深部切口SSI或器官间隙SSI。基于队列中HbA1c或BMI的分布进行包括多变量Cox回归和Kaplan-Meier曲线比较在内的统计分析。
共有2809例患者术前行HbA1c测量并接受乳房重建。其中，2025例（72.1%）接受异体重建，784例（27.9%）接受自体重建。整个队列的中位年龄为54岁，中位HbA1c为5.7（四分位间距，5.3 - 6.4），中位BMI为29.4 kg/m²（四分位间距，25.5 - 33.9）。自体组和异体组的30天并发症发生率分别为11.7%和7.5%。用于比较30天伤口并发症绝对风险的Kaplan-Meier曲线显示，HbA1c四分位数曲线之间无显著差异（对数秩检验P = 0.46）。对于BMI，与第一四分位数相比，第三四分位数（中位BMI，31.5 kg/m²）和第四四分位数（中位BMI，37.3 kg/m²）的并发症发生率增加了一倍多（第一四分位数：5.0%，第二四分位数：7.3%，第三四分位数：11.1%，第四四分位数：11.4%；P < 0.001）。第三BMI四分位数30天并发症风险的调整后风险比为1.83（95%置信区间，1.21 - 2.77；P = 0.004），第四四分位数为1.80（95%置信区间，1.18 - 2.76；P = 0.007）。
本研究表明，较高的BMI与乳房重建术后伤口并发症相关。以第一BMI四分位数为参照，在异体组中，BMI四分位数4的患者并发症风险增加75%，而在自体组中风险增加超过1.4倍。未观察到HbA1c水平与并发症有类似关联。
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