J. Huang1, A. Chagpar1 1Yale University School Of Medicine,New Haven, CT, USA
Introduction: The rate of CPM has been increasing amongst patients with unilateral breast cancer. There is a paucity of data, however, regarding the impact of CPM on complications requiring reoperation within 90 days, and length of hospital stay (LOS).
Methods: Medical records of female patients presenting with unilateral breast cancer who underwent a mastectomy at a large academic institution between July 2013-July 2016 were analyzed to determine the effect of CPM on complications requiring reoperation within 90 days of surgery, and LOS. Non-parametric statistical analyses were performed using SPSS version 24.
Results: 471 patients were included in this cohort; 276 (58.6%) opted for CPM. Median patient age was 52 (range; 22-90). Patients opting for CPM tended to be younger (median age 48 vs. 61, p<0.001), have a BRCA mutation (13.0% vs. 1.5%, p<0.001), have smaller invasive tumors (0.8 cm vs. 1.6 cm, p<0.001), have private insurance (74.6 vs. 63.6%, p<0.001), have had neoadjuvant chemotherapy (CTx, 33.0% vs. 19.1%, p=0.001), and be more likely to opt for reconstruction (94.2% vs. 57.4%, p<0.001) than those who had unilateral mastectomy (UM). CPM patients were more likely to be white or black; less likely to be Asian (p=0.025). Body mass index (p=0.653), smoking status (p=0.746), receipt of adjuvant CTx (p=0.082), receipt of radiation therapy (p=0.482), and history of diabetes (p=0.294) were not significantly different between the two groups. 52 patients (11.0%) had a complication within 90 days requiring reoperation; however, the rate of complications among CPM patients was no different than that among UM patients (11.2% vs. 10.8%, p=1.000). Median LOS for the overall cohort was 2 days. CPM patients tended to have longer LOS than UM patients (median 3 vs. 2 days, p<0.001); however, their rate complications within the initial hospital stay was the same as for UM patients (3.6% vs. 4.1%, p=0.811). Controlling for factors that were associated with CPM on bivariate analysis, CPM remained a significant independent predictor of LOS ≥ 2 days (OR=2.369; 95% CI: 1.197-4.688, p=0.013). Older age (OR=1.041; 95% CI: 1.009-1.075, p=0.012) and reconstruction (p<0.001) were also predictors of longer LOS. Compared to those who did not have reconstruction, those who opted for implant based reconstruction (OR=6.791; 95% CI: 3.247-14.201, p<0.001) and those who opted for flap based reconstruction (OR=196.522; 95% CI: 42.315-912.708, p<0.001) were more likely to have a LOS ≥ 2 days, controlling for other factors.
Conclusion: Over 50% of patients with unilateral breast cancer who underwent mastectomy opted for CPM. CPM is associated with an increased LOS, but this is not due to a higher complication rate, and there is no association between CPM and 90 day reoperation rate. These data suggest that the risk of greater complications should not be a significant detractor in decision-making regarding CPM.