The Northeastern Society of Plastic Surgeons

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The Influence of Connective Tissue Disease on Outcomes in Autologous Breast Reconstruction
Austin D. Chen, Anmol S. Chattha, BA, Alexandra Bucknor, MBBS, MRCS, MSc, Bernard T. Lee, MD, MBA, MPH, FACS, Samuel J. Lin, MD, MBA, FACS.
Beth Israel Deaconess Medical Center, Boston, MA, USA.

Patients with connective tissue disease (CTD), or collagen vascular disease, are at risk of higher morbidity after autologous breast reconstruction. However, previous studies on this topic are limited by small patient numbers. We investigated the complication profile in CTD vs. non-CTD patients undergoing immediate autologous breast reconstruction on a national scale.
A retrospective analysis of the Healthcare Cost and Utilization Project National Inpatient Sample Database (NIS) between 2010-2014 was conducted for patients ≥18 years admitted for immediate autologous breast reconstruction. Connective tissue disease was defined as systemic lupus erythematosus, rheumatoid arthritis, systemic sclerosis, scleroderma, Raynaud's syndrome, psoriatic arthritis or sarcoidosis. Wilcoxon-Mann-Whitney was used to compare continuous variables and the Pearson χ2 was used for categorical variables. Outcomes of interest were assessed using multiple linear regressions for continuous variables and multiple logistic regressions for categorical variables.
There were 22,064 patients admitted for immediate autologous breast reconstruction from 2010 to 2014. Of these patients, 21,657 (98.2%) did not have CTD and 408 (1.8%) did. The CTD patients were significantly more likely to be of African American ethnicity (19.6% vs. 15.0%, p=0.010). In addition, they were more often diabetic (13.0% vs. 7.7%, p<0.001), in the fourth quartile of income (47.1% vs. 40.6% p=0.009) and admitted to urban, non-teaching hospitals (24.5% vs. 17.7%, p<0.001). They were more likely to have a bilateral mastectomy with immediate reconstruction (49.3% vs. 42.1%, p=0.004), with greater long-term steroid (1.2% vs. 0.2%, p=0.002), NSAID (1.2% vs. 0.1%, p<0.001) and anticoagulant use (1.2% vs. 0.4%, p=0.035). After adjustment for potential confounders, CTD patients had a significantly higher incidence of wound-based complications (2.5% vs. 0.6%, p<0.001), hematoma/hemorrhage/seroma (9.6% vs. 4.2%, p=0.009) and transfusion (13.5% vs. 11.1%, p=0.002).
Autologous breast reconstruction is an important part of treatment for many women with breast cancer. As such, identification of potential risk factors for complications is of great importance. In the present study, connective tissue disease is associated with a higher incidence of wound-based complications, hematoma, hemorrhage, seroma and transfusion following autologous breast reconstruction. Clinicians should be aware of this increased risk and take appropriate, precautionary measures.
Table 1. CTD* vs. Non-CTD Outcomes

Patient OutcomesCTDNon-CTDp-value
Major complications25(6.2)1282(6.0)<0.001
Postoperative infection10(2.5)163(0.8)0.659
Wound complication10(2.5)124(0.6)<0.001

*CTD = connective tissue disease

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