Combining Breast and Ovarian Operations Increases Complications

Dominic Henn, M.D.; Janos A. Barrera, M.D.; Dharshan Sivaraj, B.S.; John Q. Lin, B.S.; Nada M. Rizk, M.S.; Irene Ma, M.D.; Geoffrey C. Gurtner, M.D.; Gordon K. Lee, M.D.; Rahim S. Nazerali, M.D., M.H.S.

Disclosures

Plast Reconstr Surg. 2022;149(5):1050-1059. 

In This Article

Patients and Methods

A retrospective chart review of 145 female patients who had undergone breast surgery and salpingo-oophorectomy at Stanford University Medical Center between 2004 and 2019 either as combined procedures (n = 87) or as two separate procedures (n = 58) was conducted. All separate procedures had been performed within a time frame of 6 months of each other. The primary outcome measures were overall complications, complications related to the breast surgery, and complications related to salpingo-oophorectomy (within 30 days after surgery). Overall complications were defined by at least one diagnosis of delayed wound healing, wound dehiscence, infection, skin necrosis, fat necrosis, hematoma, seroma, or reoperation. All infections were local cellulitis. Wound dehiscence was defined as a partial separation of the previously approximated wound margins. Delayed wound healing was defined by the presence of an open wound 14 days postoperatively. A protocol for enhanced recovery after surgery was followed for patients with autologous breast reconstructions. The study was approved by the Stanford University Institutional Review Board (IRB-49366).

Statistical Analysis

Continuous variables were compared between the groups using t test or the Mann-Whitney U test in case of non-Gaussian distribution. Normality was assessed using the D'Agostino-Pearson omnibus K2 test. Categorical variables were compared using the Fisher's exact test. Multiple logistic regression models were used to compute odds ratios and 95 percent confidence intervals to determine significant associations between overall complications or breast-related complications (dependent variables) and combined surgery and potential confounding variables (i.e., age, body mass index, race, smoking, diabetes, cardiovascular disease, American Society of Anesthesiologists class 3, and history of chemotherapy and radiation therapy). The goodness of fit of the model was examined by calculating the area under the receiver operating characteristic curve. Data are presented as mean ± SD in case of normal distribution. Non–normally distributed data are presented as median and interquartile range. Values of p ≤ 0.05 were considered statistically significant. All statistical tests were two-tailed; p value adjustment for multiple testing was performed using the Benjamini-Hochberg procedure. Statistical analysis was performed using R (version 3.6, www.r-project.org).

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