Is immediate breast reconstruction safe in women over 70? An analysis of the National Surgical Quality Improvement Program (NSQIP) database

• Published in: Breast cancer research and treatment Vol. 177; no. 1; pp. 215 - 224
• Main Authors: Angarita, Fernando A., Dossa, Fahima, Zuckerman, Jesse, McCready, David R., Cil, Tulin D.
• Format: Journal Article
• Language: English
• Published: New York Springer US 01-08-2019; Springer; Springer Nature B.V
• Subjects: Adult; Age; Age Factors; Age groups; Aged; Breast cancer; Breast Neoplasms - epidemiology; Breast Neoplasms - surgery; Breast surgery; Cancer research; Comorbidity; Epidemiology; Female; Health aspects; Health risk assessment; Humans; Invasiveness; Mammaplasty; Mammaplasty - adverse effects; Mammaplasty - methods; Mammaplasty - statistics & numerical data; Mastectomy; Medicine; Medicine & Public Health; Middle Aged; Morbidity; Mortality; Oncology; Postoperative Complications - epidemiology; Public Health Surveillance; Quality control; Quality improvement; Statistical analysis; Surgery; Thromboembolism; Time Factors; United States - epidemiology; Women; Wounds; Young Adult; United States; Aged; Breast reconstruction; Postoperative outcomes; Breast neoplasm
• ISSN: 0167-6806; 1573-7217
• DOI: 10.1007/s10549-019-05273-1

Purpose
The safety of immediate breast reconstruction (IBR) in older women is largely unknown. This study aimed to determine the 30-day postoperative complication rates following IBR (implant-based or autologous) in older women (≥ 70 years) with breast cancer and to compare them to younger women (18–69 years).
Methods
The National Surgical Quality Improvement Program (NSQIP) database was used to identify women with in situ or invasive breast cancer who underwent IBR (2005–2016). Outcomes included 30-day postoperative morbidity and mortality, which were compared across age groups stratified by type of reconstruction.
Results
Of 28,850 women who underwent implant-based and 9123 who underwent autologous reconstruction, older women comprised 6.5% and 5.7% of the sample, respectively. Compared to younger women, older women had more comorbidities, shorter operative times, and longer length of hospital stay. In the implant-based reconstruction group, the 30-day morbidity rate was significantly higher in older women (7.5% vs 5.3%,
p 
< 0.0001) due to higher rates of infectious, pulmonary, and venous thromboembolic events. Wound morbidity and prosthesis failure occurred equally among age groups. In the autologous reconstruction group, there was no statistically significant difference in the 30-day morbidity rates (older 9.5% vs younger 11.6%,
p 
= 0.15). Both wound morbidity and flap failure rates were similar between the two age groups. For both reconstruction techniques, mortality within 30 days of breast surgery was rare.
Conclusion
Immediate breast reconstruction is safe in older women. These data support the notion that surgeons should discuss IBR as a safe and integral part of cancer treatment in well-selected older women.