TY - JOUR
T1 - Individualized Risk Prediction Tool for Serious Wound Complications After Mastectomy With and Without Immediate Reconstruction
AU - CDC Prevention Epicenter Program
AU - Nickel, Katelin B.
AU - Myckatyn, Terence M.
AU - Lee, Clara N.
AU - Fraser, Victoria J.
AU - Olsen, Margaret A.
N1 - Funding Information:
We thank Cherie Hill and Dorothy Sinclair for database and computer management support. The study was funded by grant U54CK000482 from the Centers for Disease Control and Prevention (VJF). REDCap at Washington University School of Medicine is supported by the Clinical and Translational Science Award UL1 TR000448 and Siteman Comprehensive Cancer Center and NCI Cancer Center Support Grant P30 CA091842.
Funding Information:
Margaret A. Olsen reports consultant work and grant funding from Pfizer for work outside the submitted manuscript. Victoria J. Fraser reports that her spouse is the Chief Clinical Officer at Cigna Corporation. Terence M. Myckatyn reports advisory board membership, investigator-initiated grant, and device development royalties for RTI Surgical. He reports former investigator-initiated grants and advisory board work with Allergan, and an unencumbered research award from Sientra. Clara N. Lee was supported by a grant from the Agency for Healthcare Research and Quality (R18 HS026699-01A1). The remaining authors have no conflicts of interest.
Publisher Copyright:
© 2022, Society of Surgical Oncology.
PY - 2022/11
Y1 - 2022/11
N2 - Background: A greater proportion of patients with surgical risk factors are undergoing immediate breast reconstruction after mastectomy, resulting in the need for better risk prediction to inform decisions about the procedure. The objective of this study was to leverage clinical data to restructure a previously developed risk model to predict serious infectious and noninfectious wound complications after mastectomy alone and mastectomy plus immediate reconstruction for use during a surgical consultation. Methods: The study established a cohort of women age 21 years or older treated with mastectomy from 1 July 2010 to 31 December 2015 using electronic health records from two hospitals. Serious infectious and non-infectious wound complications, defined as surgical-site infection, dehiscence, tissue necrosis, fat necrosis requiring hospitalization, or surgical treatment, were identified within 180 days after surgery. Risk factors for serious wound complications were determined using modified Poisson regression, with discrimination and calibration measures. Bootstrap validation was performed to correct for overfitting. Results: Among 2159 mastectomy procedures, 1410 (65.3%) included immediate implant or flap reconstruction. Serious wound complications were identified after 237 (16.8%) mastectomy-plus-reconstruction and 30 (4.0%) mastectomy-only procedures. Independent risk factors for serious wound complications included immediate reconstruction, bilateral mastectomy, higher body mass index, depression, and smoking. The optimism-corrected C statistic of the risk prediction model was 0.735. Conclusions: Immediate reconstruction, bilateral mastectomy, obesity, depression, and smoking were significant risk factors for serious wound complications in this population of women undergoing mastectomy. Our risk prediction model can be used to counsel women before surgery concerning their individual risk of serious wound complications after mastectomy.
AB - Background: A greater proportion of patients with surgical risk factors are undergoing immediate breast reconstruction after mastectomy, resulting in the need for better risk prediction to inform decisions about the procedure. The objective of this study was to leverage clinical data to restructure a previously developed risk model to predict serious infectious and noninfectious wound complications after mastectomy alone and mastectomy plus immediate reconstruction for use during a surgical consultation. Methods: The study established a cohort of women age 21 years or older treated with mastectomy from 1 July 2010 to 31 December 2015 using electronic health records from two hospitals. Serious infectious and non-infectious wound complications, defined as surgical-site infection, dehiscence, tissue necrosis, fat necrosis requiring hospitalization, or surgical treatment, were identified within 180 days after surgery. Risk factors for serious wound complications were determined using modified Poisson regression, with discrimination and calibration measures. Bootstrap validation was performed to correct for overfitting. Results: Among 2159 mastectomy procedures, 1410 (65.3%) included immediate implant or flap reconstruction. Serious wound complications were identified after 237 (16.8%) mastectomy-plus-reconstruction and 30 (4.0%) mastectomy-only procedures. Independent risk factors for serious wound complications included immediate reconstruction, bilateral mastectomy, higher body mass index, depression, and smoking. The optimism-corrected C statistic of the risk prediction model was 0.735. Conclusions: Immediate reconstruction, bilateral mastectomy, obesity, depression, and smoking were significant risk factors for serious wound complications in this population of women undergoing mastectomy. Our risk prediction model can be used to counsel women before surgery concerning their individual risk of serious wound complications after mastectomy.
UR - http://www.scopus.com/inward/record.url?scp=85134315430&partnerID=8YFLogxK
U2 - 10.1245/s10434-022-12110-1
DO - 10.1245/s10434-022-12110-1
M3 - Article
C2 - 35831524
AN - SCOPUS:85134315430
SN - 1068-9265
VL - 29
SP - 7751
EP - 7764
JO - Annals of Surgical Oncology
JF - Annals of Surgical Oncology
IS - 12
ER -