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Burden of preoperative cardiovascular disease risk factors on breast cancer surgery outcomes

Brian Z Huang1,2, Melissa S Camp1,3

  • 1The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.

Journal of Surgical Oncology
|July 10, 2016
PubMed

Insights

Cardiovascular disease significantly impacts breast cancer surgery outcomes. Preoperative cardiac risk factors, including chronic conditions and acute events, increase the risk of complications, reoperation, and readmission.

Area of Science:

  • Oncology
  • Cardiology
  • Surgical Outcomes Research

Background:

  • Cardiovascular comorbidities in breast cancer surgery patients are understudied.
  • A comprehensive assessment of preoperative cardiac risk factors' impact on surgical outcomes is lacking.

Purpose of the Study:

  • To comprehensively assess the severity and influence of preoperative cardiac risk factors on 30-day postoperative outcomes in breast cancer surgery patients.
  • To evaluate the association between chronic conditions, acute cardiac events, past cardiac procedures, and postoperative complications, reoperation, and readmission.

Main Methods:

  • Analysis of 78,338 breast cancer surgery patients from the 2006-2012 National Surgical Quality Improvement Program (NSQIP) database.
  • Estimation of the impact of chronic conditions (diabetes, hypertension, obesity, smoking), acute cardiac events (myocardial infarction, congestive heart disease, angina), and prior cardiac procedures on 30-day postoperative complications, reoperation, and readmission.

Main Results:

  • Nearly 65% of patients had chronic conditions; <1% had acute events; 3% had past procedures.
  • Low prevalence of outcomes: 5% complications, 4% reoperation, 4% readmission. Over 65% of complications were wound-related.
  • All risk factor categories were associated with complications. Acute events showed the strongest effect (OR 3.54-4.18). Chronic conditions and past procedures predicted reoperation and readmission (ORs 1.57-2.68). Increased number of chronic conditions correlated with higher odds of all outcomes (ptrend < 0.001).

Conclusions:

  • Cardiovascular disease significantly impacts surgical outcomes in breast cancer patients, even those considered low-risk.
  • Preoperative cardiac risk factors are critical determinants of postoperative complications, reoperation, and readmission following breast cancer surgery.
Abstract

Keywords:
30-day postoperative outcomesbreast cancer surgerycardiovascular diseasecomplicationsreadmissionreoperation

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