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Increased Postoperative Complications in Bilateral Mastectomy Patients Compared to Unilateral Mastectomy: An Analysis of NSQIP Database Osman F, Saleh.

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Presentation on theme: "Increased Postoperative Complications in Bilateral Mastectomy Patients Compared to Unilateral Mastectomy: An Analysis of NSQIP Database Osman F, Saleh."— Presentation transcript:

1 Increased Postoperative Complications in Bilateral Mastectomy Patients Compared to Unilateral Mastectomy: An Analysis of NSQIP Database Osman F, Saleh F, Corrigan M, Jackson T, Cil T. University of Toronto, Toronto, Canada

2 Introduction Introduction The rate of contralateral prophylactic mastectomy among women with unilateral breast cancer has increased Incidence of contralateral breast cancer is very low Post-operative complications: Bilateral > Unilateral?

3 Method Unilateral and Bilateral Mastectomies with SLNB 4,219 Unilateral Mastectomy with SLNB 3, 722 Bilateral Mastectomy with SLNB 497 ACS- NSQIP Data All Mastectomy Patients N= 20,322 Ambiguous coding and Missing Data N= 714 Other procedures (Reconstruction, Axillary dissection etc.) N= 12, 769 Two Sentinel Node Biopsy Code N= 1,426 High Risk Pre-operative Characteristics Steroids, Infections Dialysis, Etc. N= 1194

4 Results: Baseline Characteristics Unilateral Mastectomy and sentinel lymph node biopsy N (%) Bilateral Mastectomy and sentinel lymph node biopsy N (%) P-Value N = 4,2193,722(88.2)497 (11.8)N/A Mean Age (  SD)64.2 (13.0)58.6 (11.8)P<0.001 Hypertension1,979 (50.1)182 (39.1)P<0.001 ASA b P=0.020 ASA 1177 (4.5)26 (5.6) ASA 22,362 (59.8)306 (65.8) ASA 31,363 (34.5)130 (28.0) ASA 446 (1.2)3 (0.7) Diabetic509 (12.9)37 (8.0)P<0.002 Mean BMI (  SD) c 28.4 (6.9)29.2 (7.1)P=0.024 Coronary Artery disease185 (4.7)15 (3.2)P=0.193 COPD d 145 (3.7)9 (1.9)P=0.060 ETOH e 49 (1.2)5 (1.1)P=1.000 Smoker a 565 (14.3)65 (14.0)P<0.846 Chemotherapy f 48 (1.2)13 (2.8)P=0.011

5 Results Complication Unilateral Mastectomy and SLNB N (%) Bilateral Mastectomy and SLNB N (%) OR (95% CI) Overall Complications ** 164 (4.2)39 (7.6)1.9 (1.3 –2.8) Wound ** 106 (2.9)29 (5.8)2.1 ( ) Infectious ** 29 (0.8)11 (2.2)2.9 ( ) Respiratory5 (0.1)0 (0.0)(0.0, 5.8) Thromboembolic10 (0.3)1 (0.2)0.7 (0.0, 5.3) Renal1 (0.03)0 (0.0)N/A Neurologic3 (0.1)1 (0.2)2.5 (0.04, 31.2) Cardiac2 (0.1)0 (0.0)0.0 (0.0, 14.4) Bleeding15 (0.4)0 (0.0)0.0 (0.0, 1.9) **P-value <0.05

6 Multivariable Analysis of Overall Complications OR (95% CI)P-Value Bilateral vs. Unilateral mastectomy with sentinel lymph node biopsy 1.9 ( )0.001 Age1.01 ( )0.132 Diabetes1.3 ( )0.213 Smoker2.2 ( )<0.001 Body Mass Index1.1 ( )<0.001 Chronic obstructive pulmonary disease 1.3 ( )0.495 Coronary artery disease1.4 ( )0.246 Hypertension1.0 ( )0.900 ASA 3 and 4*1.0 ( )0.721 Chemotherapy0.9 ( )0.877

7 Limitations of the Study Only Short-term outcomes (30-day) Cancer stage not reported in NSQIP data Procedural codes: CPM No Reconstruction

8 Conclusion Bilateral mastectomy appears to be associated with an increased risk of overall post-operative wound and other infections. Further studies are warranted to examine short term and long-term complications of CPM and whether these complications delay treatment.


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