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J Reconstr Microsurg 2023; 39(03): 214-220
DOI: 10.1055/s-0042-1755258
Original Article

Risk Factors Associated with Adverse Outcomes after Ablative Surgery for Lymphedema

Annet S. Kuruvilla    *
1   Division of Plastic Surgery, Department of Surgery, Stony Brook University, Renaissance School of Medicine, Stony Brook, New York
,
Annie Laurie W. Shroyer   *
1   Division of Plastic Surgery, Department of Surgery, Stony Brook University, Renaissance School of Medicine, Stony Brook, New York
,
Xiaoning Li
1   Division of Plastic Surgery, Department of Surgery, Stony Brook University, Renaissance School of Medicine, Stony Brook, New York
,
Jie Yang
1   Division of Plastic Surgery, Department of Surgery, Stony Brook University, Renaissance School of Medicine, Stony Brook, New York
,
Sagar R. Mulay
1   Division of Plastic Surgery, Department of Surgery, Stony Brook University, Renaissance School of Medicine, Stony Brook, New York
,
Sohaib M. Agha
1   Division of Plastic Surgery, Department of Surgery, Stony Brook University, Renaissance School of Medicine, Stony Brook, New York
,
Raymond M. Bellis
1   Division of Plastic Surgery, Department of Surgery, Stony Brook University, Renaissance School of Medicine, Stony Brook, New York
,
Harmehar K. Kohli
1   Division of Plastic Surgery, Department of Surgery, Stony Brook University, Renaissance School of Medicine, Stony Brook, New York
,
Henry J. Tannous   **
1   Division of Plastic Surgery, Department of Surgery, Stony Brook University, Renaissance School of Medicine, Stony Brook, New York
,
Aleksandra Krajewski   **
1   Division of Plastic Surgery, Department of Surgery, Stony Brook University, Renaissance School of Medicine, Stony Brook, New York
› Author Affiliations Funding None.
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Abstract

Background Postmastectomy breast cancer lymphedema poses an important health threat. Historically, physical therapy was the exclusive treatment option. More recently, lymphedema surgery has revolutionized care. As a first-in-kind, multicenter report, the postmastectomy breast cancer patients' risk factors associated with postlymphedema ablative surgical outcomes were documented.

Methods Using the New York Statewide Planning and Research Cooperative System database from 2010 to 2018, multivariable models identified the postmastectomy breast cancer lymphedema surgical patients' characteristics associated with major adverse outcomes and mortality.

Results Of 65,543 postmastectomy breast cancer patients, 1,052 lymphedema surgical procedures were performed including 393 (37.4%) direct excisions and 659 (63.6%) liposuctions. Direct excision and liposuction surgical patients had median ages of 58 and 52 years, respectfully (p < 0.001). Although a 30-day operative mortality was rare (0.3%, all direct excisions), major adverse outcomes occurred in 154 patients (28.5% direct excision; 6.4% liposuction; p < 0.0001). Multivariable clinical outcomes model identified that patients with higher Elixhauser's score, renal disease, emergent admissions, and direct excision surgery had higher incidences of adverse outcomes (all p < 0.01). For those patients with 30-day readmissions (n = 60), they were more likely to have undergone direct excision versus liposuction (12.5 vs. 1.7%; p < 0.0001). The important risk factors predictive of future cellulitis/lymphangitis development included diabetes mellitus, Medicaid insurance, renal disease, prior cellulitis/lymphangitis, chronic obstructive pulmonary disease (COPD), and chronic steroid use (all p < 0.01).

Conclusion Lymphedema surgery carries a favorable risk profile, but better understanding the “high-risk” patients is critical. As this new era of lymphedema surgery progresses, evaluating the characteristics for adverse postoperative outcomes is an important step in our evolution of knowledge.

Keywords

lymphedema - breast cancer - mastectomy - lymphedema surgery - ablative surgery - risk factors

* Both Ms. Kuruvilla and Dr. Shroyer should be considered co-first authors.


** Both Drs. Tannous and Krajewski should be considered co-last authors.


Supplementary Material



Publication History

Received: 17 December 2021

Accepted: 29 May 2022

Article published online:
26 September 2022

© 2022. Thieme. All rights reserved.

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