The impact of body mass index on oncoplastic breast surgery: A multicenter analysis.

BACKGROUND Obesity has nearly tripled in the last 50 years. During the last decades, oncoplastic breast surgery has become an important choice in the surgical treatment of breast cancer. An association exists between higher body mass index (BMI) and wound complications for major operations, but there is scarce literature on oncoplastic surgery. Hence, our aim was to compare the complication rates among patients who underwent oncoplastic surgery, stratified by BMI. METHODS Patient data were analyzed from the National Surgical Quality Improvement Program database (NSQIP) for oncoplastic breast procedures (2005-2020). Patients were stratified according to World Health Organization obesity classifications. Multivariate logistic regression was performed to assess risk factors for complications (overall, operative, and wound-related). RESULTS From a total of 6887 patients who underwent oncoplastic surgery, 4229 patients were nonobese, 1380 had Class 1 obesity (BMI: 30 to <35 kg/m2 ), 737 Class 2 obesity (BMI: 35 to <40 kg/m2 ), and 541 Class 3 obesity (BMI: ≥ 40 kg/m2 ). Greater operative time was found according to higher BMI (p < 0.001). Multivariate analysis adjusted for baseline characteristics showed that patients with obesity Class 2 (odds ratio [OR] = 1.51, 95% confidence interval [CI]: 1.03-2.23, p = 0.037) and 3 (OR = 1.87, 95% CI 1.24-2.83, p = 0.003) had increased risk of overall and wound complications compared with Nonobese patients. Comparing obese with nonobese patients, there were no differences in rates of deep SSI, organ/space SSI, pneumonia, reintubation, pulmonary embolism, deep vein thrombosis, urinary tract infection, stroke, bleeding, postoperative sepsis, length of stay, and readmission. CONCLUSIONS Oncoplastic surgery is a safe procedure for most patients. However, caution should be exercised when performing oncoplastic surgery for patients with Class 2 or 3 obesity (BMI ≥ 35 kg/m2 ), given there was a higher rate of overall and wound-specific complications, compared with patients who were not obese or had Class 1 obesity.

[1]  A. Chatterjee,et al.  The adoption of oncoplastic surgery: Is there a learning curve? , 2023, Journal of surgical oncology.

[2]  A. Chatterjee,et al.  Single Versus Dual Surgeon Approaches to Oncoplastic Surgery: A Comparison of Outcomes. , 2023, The Journal of surgical research.

[3]  R. Rajani,et al.  Cost of OR Time is $46.04 per Minute , 2022, Journal of Orthopaedic Business.

[4]  B. Smith,et al.  Comparison of BMI on operative time and complications of robotic inguinal hernia repair at a VA medical center , 2022, Surgical Endoscopy.

[5]  A. Jemal,et al.  Cancer statistics, 2022 , 2022, CA: a cancer journal for clinicians.

[6]  N. Napoli,et al.  The Association of Body Mass Index with Surgical Time Is Mediated by Comorbidity in Patients Undergoing Total Hip Arthroplasty , 2021, Journal of clinical medicine.

[7]  S. Naber,et al.  Examining a decade of racial disparity in partial mastectomy and oncoplastic surgery , 2022, Journal of surgical oncology.

[8]  J. Margenthaler,et al.  The Landmark Series: Breast Conservation Trials (including oncoplastic breast surgery) , 2021, Annals of Surgical Oncology.

[9]  I. Helenowski,et al.  The Effect of Obesity on Operating Room Utilization in Breast Surgery. , 2020, The Journal of surgical research.

[10]  A. Chagpar,et al.  Do Obese Breast Cancer Patients Have More Complications and a Longer Length of Stay After Mastectomy Than Nonobese Patients? , 2020, The American surgeon.

[11]  A. Losken,et al.  A Cost–Utility Analysis Comparing Immediate Oncoplastic Surgery to Delayed Oncoplastic Surgery in Smoking Breast Cancer Patients , 2020, Annals of Surgical Oncology.

[12]  S. Naber,et al.  Managing Positive Margins After Oncoplastic Surgery , 2020, The American surgeon.

[13]  Theo J M Ruers,et al.  Understanding the Costs of Surgery: A Bottom-Up Cost Analysis of Both a Hybrid Operating Room and Conventional Operating Room , 2020, International journal of health policy and management.

[14]  C. Kaufman.  Increasing Role of Oncoplastic Surgery for Breast Cancer , 2019, Current Oncology Reports.

[15]  A. Chatterjee,et al.  An Oncoplastic Surgery Primer: Common Indications, Techniques, and Complications in Level 1 and 2 Volume Displacement Oncoplastic Surgery , 2019, Annals of Surgical Oncology.

[16]  A. Chatterjee,et al.  Practical Perspectives Regarding Patient Selection and Technical Considerations in Oncoplastic Surgery , 2019, Current Breast Cancer Reports.

[17]  D. Holmes,et al.  A Consensus Definition and Classification System of Oncoplastic Surgery Developed by the American Society of Breast Surgeons , 2019, Annals of Surgical Oncology.

[18]  A. Chatterjee,et al.  Surgical trends in breast cancer: a rise in novel operative treatment options over a 12 year analysis , 2018, Breast Cancer Research and Treatment.

[19]  T. Meyer,et al.  The influence of obesity on operating room time and perioperative complications in cochlear implantation , 2017, World journal of otorhinolaryngology - head and neck surgery.

[20]  Y. Seto,et al.  Obesity as a surgical risk factor , 2017, Annals of gastroenterological surgery.

[21]  H. Kuerer,et al.  Operative and Oncologic Outcomes in 9861 Patients with Operable Breast Cancer: Single-Institution Analysis of Breast Conservation with Oncoplastic Reconstruction , 2016, Annals of Surgical Oncology.

[22]  R. Winfield,et al.  Obesity and the Risk for Surgical Site Infection in Abdominal Surgery , 2016, The American surgeon.

[23]  Yuan-jun Teng,et al.  Does Obesity Affect the Surgical Outcome and Complication Rates of Spinal Surgery? A Meta-analysis , 2014, Clinical orthopaedics and related research.

[24]  S. Lipsitz,et al.  Body Mass Index as a Predictor of Postoperative Complications in Reduction Mammaplasty , 2012, Plastic and reconstructive surgery.

[25]  Margaret S. Villers,et al.  Complications of cesarean delivery in the massively obese parturient. , 2010, American journal of obstetrics and gynecology.

[26]  E. Dellinger,et al.  The obese surgical patient: a susceptible host for infection. , 2006, Surgical infections.

[27]  Ron D. Shippert.  A Study of Time-Dependent Operating Room Fees and How to save $100 000 by Using Time-Saving Products , 2005 .

[28]  C. Baker,et al.  Breast Cancer Treatment. , 2021, American family physician.