An analysis of underweight status on 30-day outcomes after breast reconstruction

Aim:To examine the impact of underweight body mass index(BMI)values on breast reconstruction outcomes.Methods:The American College of Surgeons National Surgical Quality Improvement Program(ACS-NSQIP)database was retrospectively reviewed for all patients who underwent breast reconstruction between 2006 and 2011.Patients were first stratified by breast reconstruction modality into prosthetic or autologous cohorts,and second by BMI values into underweight(BMI<18.5),normal to overweight(reference,BMI 18.5-29.99),moderate obesity(BMI 30-34.99),severe obesity(BMI 35-39.99),and morbid obesity cohorts.Multivariate logistic regression models were used to determine independent predictors of complications.Results:With regard to prosthetic breast reconstruction patients,obese patients demonstrated increased rates of surgical complications,while underweight patients did not have any differences on multivariable analysis.With respect to autologous reconstruction,risk-adjusted multivariate regression models showed a dose dependent response between obesity and risk for surgical complications and reoperation,but not for underweight patients.Conclusion:On multivariable analysis of over 4,600 patients,there were no significant differences in the rates of adverse events between underweight patients(BMI<18.5)and their reference-weight counterparts,in spite of a significant increase in surgical and medical complication rates in underweight patients on univariate analysis.

Use of negative pressure wound therapy in pediatric oncology patients:a single-center review of 66 patients

Aim:Negative pressure wound therapy(NPWT)has been studied extensively in adult patients,but less is known about pediatric patients.This study assesses the efficacy and safety of vacuum-assisted closure®usage in pediatric oncology patients.Methods:Retrospective data on all patients treated with NPWT at a single pediatric oncology hospital were collected between April 2005 and September 2013.Details on pre-treatment factors,treatment course,and post-treatment events were collected.No control group was available for comparison.Results:Sixty-six patients were identified,with a total of 74 wounds.Median age at the time of NPWT application was 13 years(range,10 months-23 years).Median duration of treatment was 21 days(range,3-236 days).NPWT therapy was started with continuous high negative pressures(125 mmHg)in most patients.Sixty-nine percent of patients had their wounds healed without intervention,and 20%of patients required surgical closure.NPWT was discontinued temporarily secondary to skin maceration or cellulitis in 12%of patients.NPWT was used in a number of non-standard clinical situations,including primarily-closed incisional wound NPWT and bridging NPWT through adjuvant chemotherapy.Conclusion:In pediatric oncology patients,NPWT is safe,effective,and well-tolerated.Although this study is retrospective in nature,and there was no control group for comparison,these data are important for clinicians to guide therapy as device monitoring agencies and payors increasingly require outcomes data for the approval of therapeutic decisions.