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Individualized Risk Prediction Tool for Serious Wound Complications after Mastectomy With and Without Immediate Reconstruction
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11 2022
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Source: Ann Surg Oncol. 29(12):7751-7764
[PDF-188.13 KB]
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Alternative Title:Ann Surg Oncol
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Description:Background:
A greater proportion of patients with surgical risk factors are undergoing immediate breast reconstruction after mastectomy, resulting in the need for better risk prediction to inform decisions about the procedure. Our objective was to leverage clinical data to restructure a previously developed risk model to predict serious infectious and noninfectious wound complications after mastectomy only and mastectomy plus immediate reconstruction for use during a surgical consultation.
Methods:
We established a cohort of women ≥ 21 years of age undergoing mastectomy from 7/1/2010–12/31/2015 using electronic health records from two hospitals. Serious infectious and non-infectious wound complications, defined as surgical site infection, dehiscence, tissue necrosis, fat necrosis requiring hospitalization or surgical treatment, were identified within 180 days after surgery. Risk factors for serious wound complications were determined using modified Poisson regression, with discrimination and calibration measures. Bootstrap validation was performed to correct for overfitting.
Results:
Among 2,159 mastectomy procedures, 1,410 (65.3%) included immediate implant or flap reconstruction. Serious wound complications were identified after 237 (16.8%) mastectomy plus reconstruction and 30 (4.0%) mastectomy only procedures. Independent risk factors for serious wound complications included immediate reconstruction, bilateral mastectomy, higher body mass index, depression, and smoking. The optimism-corrected C statistic of the risk prediction model was 0.735.
Conclusions:
Immediate reconstruction, bilateral mastectomy, obesity, depression, and smoking were significant risk factors for serious wound complications in this population of women undergoing mastectomy. Our risk prediction model can be used to counsel women before surgery concerning their individual risk of serious wound complication post-mastectomy.
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Pubmed ID:35831524
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Pubmed Central ID:PMC9937777
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