B. N. Tran1, M. Singh1, A. Doval1, E. C. Levine1, D. Singhal1, B. T. Lee1 1Beth Israel Deaconess Medical Center,Plastic And Reconstructive Surgery,Boston, MA, USA
Introduction: Diabetes has been identified as one of the comorbidities that negatively affect surgical outcomes. This study aimed to quantify the impact of diabetes on outcomes of breast cancer surgery using the American College of Surgeons National Surgical Quality Improvement Program.
Methods: Patients with breast cancer diagnosis were identified from 2005 to 2015. Those who underwent lumpectomy, mastectomy, and breast reconstruction were identified. Complication rates of patients with and without diabetes for each group were compared using student t-test. A binary logistic regression was performed to identify risk factors associated with postoperative complications.
Results: There were 36,001 lumpectomies, 41,539 mastectomies, and 36,740 delayed breast reconstruction. About 2.6% of lumpectomy patients underwent immediate reconstruction, compared to 33.5% of mastectomy patients. The presence of diabetes doubled the rate of complications in all groups including lumpectomy without reconstruction (2.7% vs. 4.6%), with reconstruction (4.6% vs. 8.1%), mastectomy without reconstruction (7.1% vs. 10%), with immediate reconstruction (8.6% vs. 16.8%), implant-based delayed reconstruction (5% vs. 8.9%), autologous delayed reconstruction (17.5% vs. 26.9%), and autologous with implant delayed reconstruction (8% vs. 16.4%). Diabetic patients on insulin had higher incidence of complications compared to those on oral agents only in mastectomy group (9.8% vs.13.6%). Independent risk factors for postoperative complications were DM (OR 1.3, p<0.001), smoking (OR 1.3, p<0.001), and ASA 3 and 4 (OR 1.5, p<0.001). Any level of dependence was found to be independent risk factor for oncologic resection (OR 2.3, p<0.001).
Conclusion: Diabetes is a significant comorbidity in breast cancer surgery, both in oncologic resection and reconstruction. Complications associated with implant-based reconstruction might be undercounted due to the 30-day nature of this type of database. Patient should be counseled about the risks associated with diabetes in breast cancer surgery.
