Systemic Lupus Erythematosus in Complications of Mastectomies With or Without Reconstruction

Systemic lupus erythematosus (SLE) is a chronic autoimmune disease estimated to affect more than 200,000 patients in the United States. There is a scarcity of population-based studies of SLE as a risk factor for postoperative complications of mastectomies with or without reconstruction.

A retrospective cohort study was conducted using the TriNetX database. The exposure cohort comprised patients who underwent mastectomies with or without reconstruction with a prior diagnosis of SLE; the control cohort comprised those without. Propensity score matching (1:1) was performed. Short-term outcomes were rates of infection, wound dehiscence, bleeding, seroma, venous thromboembolism, emergency department (ED) visits, and hospitalizations at postoperative days 7, 30, and 90. Long-term outcomes were rates of revision and capsular contracture at postoperative year 2. The Cox model was used to study the relationship between preoperative medications and postoperative complications.

After matching, 1016 subjects were in each cohort. At postoperative day 90, patients with a prior diagnosis of SLE were at significantly higher risks of wound dehiscence (risk ratio [RR] 1.793, P value [P] 0.0091), bleeding (RR: 1.6, P 0.0377), pain (RR: 1.427, P 0.0129), ED visits (RR: 1.783, P < 0.0001), and hospitalizations (RR: 1.162, P 0.0403). Medication use within 30 d prior to the surgery was not significantly associated with postoperative complications.

Patients with a prior diagnosis of SLE were at significantly higher risks of wound dehiscence, bleeding, pain, ED visits, and hospitalizations following mastectomies with or without reconstruction. The data presented herein may inform perioperative management of patients with SLE.