Perioperative Outcomes and Risk Profile of 4,730 Cosmetic Breast Surgery Cases in Academic Institutions: An ACS-NSQIP Analysis.

BACKGROUND
Cosmetic breast surgery (CBS) can be subdivided into augmentation, mastopexy, reduction and reconstruction.


OBJECTIVES
We retrospectively analyzed a multi-institutional national database to investigate the outcomes of CBS and identify clinical patterns to optimize care.


METHODS
We reviewed the National Surgical Quality Improvement Program (NSQIP) database (2008-2020) to identify female patients who underwent CBS. Postoperative outcomes (30-day surgical and medical complications, reoperation, readmission, and mortality) and risk factors for complications were assessed.


RESULTS
Four thousand seven hundred-thirty patients were identified (Age: 40 ± 13 years; BMI: 24 ± 4.5 kg/m2) with augmentation accounting for 54% of cases. There were complications in 2.0% of cases. Age >65 years (p = 0.002), obesity (p < 0.0001), setting (p < 0.0001) and diabetes (p = 0.04) were risk factors for any complication. Age >65 years (p = 0.02), obesity (p = 0.03), diabetes (p = 0.01), history of chronic obstructive pulmonary disease (COPD) (p = 0.002) and congestive heart failure (CHF) (p < 0.0001), smoking in the past year (p = 0.003), setting (p = 0.007) and increased American Society of Anesthesiology (ASA) score (p < 0.0001) were predictors of surgical complications such as dehiscence and infection. Multivariable analysis confirmed that COPD, obesity class I and III, and inpatient status were independent risk factors for occurrence of any complication (p = 0.0005, 0.0003,  < 0.0001 and <0.0001, respectively). Additionally, multiple procedures (p = 0.02) and smoking (p = 0.005) were found to be risk factors for surgical complications.


CONCLUSIONS
We confirm the positive safety profile of CBS. Healthy BMI is a protective factor, while complications were more likely among inpatient procedures. A correlation between multiple procedures and increased surgical complications was identified. Awareness of these risk factors can assist surgeons to further refine their perioperative protocols.