Document Detail


Free tissue transfer in the obese patient: an outcome and cost analysis in 1258 consecutive abdominally based reconstructions.
MedLine Citation:
PMID:  23629107     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: The authors' institution has seen an increase in obese and morbidly obese patients seeking autologous breast reconstruction. The authors provide a comprehensive outcome analysis of patients undergoing abdominally based autologous breast reconstruction.
METHODS: The authors identified obese patients receiving free tissue transfer for breast reconstruction. World Health Organization body mass index criteria were used: nonobese (body mass index, 20 to 29.9 kg/m), class I (30 to 34.9 kg/m), class II (35 to 39.9 kg/m), and class III (>40 kg/m). Patient comorbidities, body mass index, complications (medical and surgical), and hospital resource use were examined.
RESULTS: Eight-hundred twelve patients undergoing 1258 free tissue transfers for breast reconstruction were included. Overall, 66.5 percent (n = 540) were considered nonobese, 22.9 percent (n = 186) had class I obesity, 5.0 percent (n = 41) had class II, and 5.7 percent (n = 45) had class III. Obesity was associated with a significant increase in minor (p = 0.001) and major (p = 0.013) complications. Morbidly obese patients had significantly higher rates of total flap loss (p = 0.006) and longer operative times (p = 0.0002). Complications translated into greater cost and resource consumption (p < 0.001). Muscle-sparing transverse rectus abdominis myocutaneous flap experienced a significantly higher rate of hernia compared with other flaps (p = 0.02), without a difference in flap loss rate (p = 0.61).
CONCLUSIONS: Increasing obesity is associated with increased perioperative risk in free abdominally based autologous breast reconstruction, which translated into greater perioperative morbidity, higher hospital cost, and increased health care resource consumption. Higher body mass index is directly related to intraoperative technical difficulty, flap loss, donor-site morbidity, and cost use.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, II.
Authors:
John P Fischer; Jonas A Nelson; Brady Sieber; Emily Cleveland; Stephen J Kovach; Liza C Wu; Joseph M Serletti; Suhail Kanchwala
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Plastic and reconstructive surgery     Volume:  131     ISSN:  1529-4242     ISO Abbreviation:  Plast. Reconstr. Surg.     Publication Date:  2013 May 
Date Detail:
Created Date:  2013-04-30     Completed Date:  2013-07-16     Revised Date:  2014-10-13    
Medline Journal Info:
Nlm Unique ID:  1306050     Medline TA:  Plast Reconstr Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  681e-92e     Citation Subset:  AIM; IM    
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MeSH Terms
Descriptor/Qualifier:
Abdominal Fat / pathology,  surgery
Abdominal Muscles / surgery
Adult
Comorbidity
Databases, Factual / statistics & numerical data
Female
Free Tissue Flaps / economics,  pathology*
Hospital Costs / statistics & numerical data
Humans
Intraoperative Complications / epidemiology*
Logistic Models
Longitudinal Studies
Mammaplasty / economics,  methods*
Microsurgery / economics,  methods
Middle Aged
Multivariate Analysis
Obesity, Abdominal / economics,  epidemiology,  surgery
Obesity, Morbid / economics,  epidemiology,  surgery*
Postoperative Complications / epidemiology*
Risk Factors
Comments/Corrections
Comment In:
Plast Reconstr Surg. 2014 May;133(5):711e-713e   [PMID:  24776574 ]
Plast Reconstr Surg. 2014 May;133(5):713e-714e   [PMID:  24776575 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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