A propensity score matched analysis of obesity as an independent risk factor for postoperative complications in reduction mammaplasty

Aim:Reduction mammaplasty is a commonly performed procedure for the treatment of symptomatic macromastia and is increasingly desired by the obese population.With the increasing prevalence obesity in the population,it is imperative to understand its effect on postoperative outcomes.The purpose of this study is to evaluate obesity as an independent risk factor for postoperative complications in breast reduction surgery using 1:1 patient matching through propensity scores between obese patients and non-obese controls.Methods:Between 2005 and 2013,the National Surgical Quality Improvement Program dataset identified a total of 6,016 patients as having undergone primary reduction mammaplasty with 30-day postoperative follow-up.Patients were divided into obese[body mass index(BMI)of 30 or more]vs.not obese(BMI below 30).Patients were initially analyzed using standard multivariable analysis.Using propensity scores obtained from a logistic regression model,patients were subsequently matched 1:1 according to preoperative and operative variables to truly isolate the effect of obesity on surgical outcomes.Outcomes were compared between the matched cohorts using McNemar’s test and the Wilcoxon signed rank test.Results:In unmatched multivariable analysis,rates of overall complications(7.2%vs.5.3%,P=0.0024),wound complications(5.5%vs.3.6%,P=0.0004),superficial surgical site infection(4.1%vs.2.8%,P=0.0050),and wound dehiscence(0.3%vs.1.1%,P=0.0005)were found to be statistically different between obese vs.non-obese,respectively.However,when comparing 1:1 matched obese and non-obese patients,only wound complications(4.6%vs.3.1%,P=0.0334)were significantly increased in the obese cohort.Conclusion:Using the most robust statistical tools available,obesity was determined to affect wound complications after breast reduction without increased detriment on other major complications when compared to the non-obese.Obesity should be a considered with other preoperative comorbidities,rather than an independent contraindication to surgery.Breast reduction appears to be safe in the obese patient who is otherwise healthy.

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.