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Obesity Portends Increasing Rates of Superficial Surgical Site Infection Following Pediatric Reduction Mammoplasty: A
Thor S Stead1, Luke Soliman, Nikhil Sobti
1From the Division of Plastic Surgery, Department of Surgery, The Warren Alpert Medical School of Brown University, Providence, RI.
Insights
Pediatric reduction mammoplasty is safe, but higher body mass index (BMI) increases the risk of superficial surgical site infection (SSI). Obese children require increased caution and infection prevention during this common procedure.
Area of Science:
- Plastic Surgery
- Pediatric Surgery
- Surgical Outcomes
Background:
- Pediatric reduction mammoplasty is increasingly performed due to rising obesity rates.
- Obesity is a leading cause of macromastia but may increase surgical complication risks.
- This study investigates the safety of pediatric reduction mammoplasty and obesity's impact on complications.
Purpose of the Study:
- To evaluate the safety of pediatric reduction mammoplasty.
- To determine if higher body mass index (BMI) is a risk factor for postoperative complications in pediatric patients undergoing reduction mammoplasty.
- To assess the association between BMI and surgical site infections (SSI).
Main Methods:
- Data from 1,589 pediatric reduction mammoplasty cases (CPT code 19318) between 2012-2020 were analyzed from the National Surgical Quality Improvement Program Pediatrics database.
- Univariate and multivariate logistic regression analyses were performed to assess the relationship between BMI and complication rates, controlling for confounders.
- Key variables included age, sex, BMI, diabetes mellitus, American Society of Anesthesiologists (ASA) class, and operative time.
Main Results:
- The mean patient age was 16.6 years, with a mean BMI of 30.5 lb/in². 49% of patients were obese.
- Superficial surgical site infection (SSI) occurred in 2.7% of patients. Other complications like dehiscence and reoperation were less than 1%.
- Multivariate analysis revealed a significant association between increasing BMI and superficial SSI (OR 1.05 per unit increase, P=0.02), even after controlling for ASA class.
Conclusions:
- Pediatric reduction mammoplasty is a safe procedure with low complication rates.
- Elevated BMI is a significant risk factor for superficial SSI following this surgery.
- Obese pediatric patients undergoing reduction mammoplasty require heightened vigilance regarding infection prevention and management.
Introduction:
Pediatric reduction mammoplasty has become increasingly common due to the obesity epidemic. While obesity remains the leading cause of macromastia leading to surgery, it may also be a risk factor for postoperative complications. This study examines the safety of pediatric reduction mammoplasty and the risk of obesity for complications following this procedure.
Methods:
The American College of Surgeons National Surgical Quality Improvement Program Pediatrics was queried to obtain all reduction mammoplasty cases from 2012 to 2020. Univariate and multivariate logistic regression analyses controlling for confounders were carried out to assess the relationship between body mass index (BMI) and rates of complication.
Results:
One thousand five hundred eighty-nine patients with the primary Current Procedural Terminology code 19318 were included in the final analysis. The mean age was 16.6 (SD, 1.1) years, and the mean BMI was 30.5 (SD, 6.2) lb/in2. Notably, 49% of the patients were obese, and 31% were overweight, while only 0.4% were underweight. Forty-three patients (2.7%) sustained a superficial surgical site infection (SSI) postoperatively. Other complications were less prevalent, including deep SSI (4 patients, 0.3%), dehiscence (11, 0.7%), reoperation (21, 1%), and readmission (26, 1.6%).Independent variables analyzed included age, sex, BMI, diabetes mellitus, American Society of Anesthesiologists (ASA) class, and operative time, of which only BMI and ASA class were found to be significantly associated with SSI on univariate analysis. On multivariate logistic regression while controlling for ASA class and the false discovery rate, there was a strong association between increasing rates of superficial SSI and increasing BMI (unit odds ratio, 1.05; 95% confidence interval, [1.01, 1.09]; P = 0.02). The OR indicates that for each 1-unit increase in BMI, the odds of SSI increase by 5%.
Conclusions:
Complications following pediatric reduction mammoplasty are uncommon, demonstrating the safety of this procedure. High BMI was found to have a significantly higher risk for superficial SSI. Increased caution and infection prophylaxis should be taken when performing this operation on obese patients.
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