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Obesity Portends Increasing Rates of Superficial Surgical Site Infection Following Pediatric Reduction Mammaplasty: A National Surgical Database Analysis
Thor S. Stead*, Luke Soliman, Nikhil Sobti, Raman Mehrzad
Department of Plastic Surgery, The Warren Alpert Medical School of Brown University, Providence, RI

Pediatric reduction mammaplasty has become increasingly common due to the obesity epidemic. While obesity remains the leading cause of macromastia leading to surgery, it may also be a risk factor for postoperative complications. This study examines the safety of pediatric reduction mammaplasty and the risk of obesity for complications following this procedure.
The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP Peds) was queried to obtain all reduction mammaplasty cases from 2012 to 2020. Univariate & multivariate logistic regression analyses controlling for confounders were carried out to assess the relationship between BMI and rates of complication.
1589 patients having primary CPT code 19318 were included in the final analysis. The mean age was 16.6 years (SD 1.1) & the mean BMI was 30.5 kg/m2 (SD 6.2). Notably, 49% of the patients were obese and 31% were overweight, while only 0.4% were underweight. 43 patients (2.7%) sustained a superficial SSI postoperatively. Other complications were less prevalent, including deep SSI (4 patients, 0.3%), dehiscence (11, 0.7%), reoperation (21, 1%), & readmission (26, 1.6%).

Independent variables analyzed included age, sex, BMI, diabetes mellitus, American Society of Anesthesiologists (ASA) class, and operative time, of which only BMI and ASA class were found to be significantly associated with SSI on univariate analysis. On multivariate logistic regression while controlling for ASA class and the false discovery rate, there was a strong association between increasing rates of superficial SSI and increasing BMI (Unit Odds Ratio 1.05, 95% CI [1.01, 1.09], p=0.02). The OR indicates that for each 1-unit increase in BMI, the odds of SSI increases by 1.05x.
Complications following pediatric reduction mammaplasty are uncommon, demonstrating the safety of this procedure. High BMI was found to have a significantly higher risk for superficial SSI. Increased caution & infection prophylaxis should be taken when performing this operation on obese patients.


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