压力之下的美：高血压对54000例美容性乳房手术结局的影响
Beauty Under Pressure: The Impact of Hypertension on Outcomes in 54,000 Cases of Esthetic Breast Surgery.
作者信息
Knoedler Samuel, Schaschinger Thomas, Friedrich Sarah, Schemet Lena, Matar Dany Y, Niederegger Tobias, Storti Gabriele, Sofo Giuseppe, Morales Paul Fernando Fajardo, Mazzarone Francesco, Orgill Dennis P, Panayi Adriana C, Kim Bong-Sung
机构信息
Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
Instituto Ivo Pitanguy, Hospital Santa Casa de Misericórdia Rio de Janeiro, Pontifícia Universidade Católica do Rio de Janeiro, Rio de Janeiro, Brazil.
出版信息
Aesthetic Plast Surg. 2025 Aug 11. doi: 10.1007/s00266-025-05089-z.
BACKGROUND
Hypertension affects nearly one-third of the global adult population and is associated with increased postoperative morbidity. However, its specific impact on outcomes of esthetic breast surgery (EBS) remains poorly understood.
METHODS
Data from the multi-institutional American College of Surgeons National Surgical Quality Improvement Program between 2008 and 2022 were analyzed. Patients undergoing elective EBS procedures (breast augmentation, breast reduction, mastopexy, and augmentation-mastopexy) were classified as either medically treated hypertensive (MedHyp) or non-hypertensive (NoMedHyp). 30-day postoperative outcomes were compared between MedHyp and NoMedHyp patients.
RESULTS
A total of 54,336 patients were included, of whom 83.5% (n = 45,373) underwent breast reduction (MedHyp: 7,625 [16.8%] vs. NoMedHyp: 37,748 [83.2%]), 12.1% (n = 6,548) breast augmentation (MedHyp: 209 [3.2%] vs. NoMedHyp: 6,339 [96.7%]), 2.3% (n = 1,237) augmentation-mastopexy (MedHyp: 90 [7.3%] vs. NoMedHyp: 1,147 [92.7%]), and 2.2% (n = 1,178) mastopexy (MedHyp: 136 [11.5%] vs. NoMedHyp: 1,042 [88.5%]). Multivariate analysis revealed a significant association between MedHyp and increased risk of medical complications (OR 1.6, 95% CI 1.1-2.2, p = 0.0070) as well as general (OR 1.5, 95% CI 1.3-1.8, p < 0.001) and any complications (OR 1.2, 95% CI 1.0-1.3, p = 0.0079) after breast reduction. MedHyp was also found to be an independent risk factor for complications after breast augmentation (OR 2.4, 95% CI 1.1-5.1, p = 0.026). No significant associations were observed for mastopexy or augmentation-mastopexy.
CONCLUSION
Medically treated hypertension appears to be an independent risk factor for postoperative complications following breast reduction and breast augmentation. These insights underscore the importance of thorough preoperative hypertension management to maximize patient safety and optimize outcomes in EBS.
LEVEL OF EVIDENCE II
This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
背景
高血压影响着全球近三分之一的成年人口，且与术后发病率增加相关。然而，其对美容性乳房手术（EBS）结果的具体影响仍知之甚少。
方法
分析了2008年至2022年间多机构的美国外科医师学会国家外科质量改进计划的数据。接受择期EBS手术（隆胸、乳房缩小术、乳房上提术和隆胸-乳房上提术）的患者被分为药物治疗高血压组（MedHyp）或非高血压组（NoMedHyp）。比较了MedHyp组和NoMedHyp组患者术后30天的结果。
结果
共纳入54336例患者，其中83.5%（n = 45373）接受了乳房缩小术（MedHyp组：7625例[16.8%] vs. NoMedHyp组：37748例[83.2%]），12.1%（n = 6548）接受了隆胸手术（MedHyp组：209例[3.2%] vs. NoMedHyp组：6339例[96.7%]），2.3%（n = 1237）接受了隆胸-乳房上提术（MedHyp组：90例[7.3%] vs. NoMedHyp组：1147例[92.7%]），2.2%（n = 1178）接受了乳房上提术（MedHyp组：136例[11.5%] vs. NoMedHyp组：1042例[88.5%]）。多因素分析显示，MedHyp组与乳房缩小术后医疗并发症风险增加（OR = 1.6，95%CI：1.1 - 2.2，p = 0.0070）、一般并发症（OR = 1.5，95%CI：1.3 - 1.8，p < 0.001）以及任何并发症（OR = 1.2，95%CI：1.0 - 1.3，p = 0.0079）之间存在显著关联。MedHyp组也是隆胸术后并发症的独立危险因素（OR = 2.4，95%CI：1.1 - 5.1，p = 0.026）。乳房上提术或隆胸-乳房上提术未观察到显著关联。
结论
药物治疗的高血压似乎是乳房缩小术和隆胸术后并发症的独立危险因素。这些见解强调了术前全面管理高血压对于在EBS中最大限度提高患者安全性和优化手术结果的重要性。
证据级别II：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，请参阅目录或在线作者指南www.springer.com/00266 。
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