Abstract P5-16-01: Is breast reconstruction safe in women over 70? An analysis of the national surgical quality improvement program (NSQIP) database
Authors: Angarita FA , McCready DR , Cil T 
Published: May 2019

Abstract
Background:Less than 14% of older women undergo post-mastectomy breast reconstruction. A major reason for the low rate is the concern about post-operative complications. A thorough analysis of surgical complications by age group is limited in previous studies. The aim of this study is to determine the surgical complication rates of older women (≥70 years old) with breast cancer who underwent breast reconstruction and compare them to younger women (18–69 years old).
Methods: Data from the National Surgical Quality Improvement Program (NSQIP) database were used to identify women with carcinoma in situ and invasive breast cancer who underwent delayed or immediate breast reconstruction (2005-2016). The primary outcome was 30-day post-operative surgical complications; the secondary outcome was 30-day mortality.Patient demographics, comorbidities, and 30-day postoperative complications and mortality rates were compared across age groups and each type of reconstruction.
Results: Of 42,929 women who underwent breast reconstruction, 2,615 (6.1%) were older women. Although compared to young women, older women were more likely to have medical comorbidities their American Society of Anesthesiologists' (ASA) classification was lower.Tumor histology distribution was similar in both groups. Lymph node surgery and neoadjuvant chemotherapy was significantly less frequent among older women. Compared to young women, older women more frequently underwent immediate breast reconstruction (IBR) [n=2,405 (92%) versus n=33,580 (88.3%), p&lt;0.0001] but less frequently underwent delayed breast reconstruction [n=209 (8%) versus n=4,734 (11.7%), p&lt;0.0001]. Prosthesis-based reconstruction was the most common technique in both age groups. Autologous reconstruction was significantly less common amongst older women than young women [n=517 (19.8%) versus n=10,011 (24.8%), p&lt;0.0001]. Older women experienced higher rates of superficial surgical site infection (SSI) [n=69 (2.6%) versus n=716, (1.8%), p=0.002] and urinary tract infection [n=15 (0.6%) versus n=101 (0.3%) p =0.005]. However, the rates of deep SSI, dehiscence, pneumonia, thromboembolism, renal complications, cardiac events, and sepsis were similar between both groups. Older women had significantly lower rates of events of bleeding requiring transfusion [n=27 (1%) versus n=736 (1.8%), p=0.002] and flap failure [n=2 (0.4%) versus n=210 (2.1%), p=0.006). Return to the operating room within 30-days was similar between older and young women [n=171 (6.5%) versus n=2,821 (7.0%,) p=0.4]. Thirty-day deaths were rare events [older n=3 (0.1%) and young n=10 (0.02%), p=0.05].
Conclusions: Overall, 30-day postoperative complications in older women who undergo breast reconstruction are extremely low. Infection rates were slightly higher in the older group however; severe complications such as flap failure, bleeding, reoperation, and death were more common in young women. Age alone did not confer an increased risk of complications after breast reconstruction. Breast reconstruction can be safely offered to older women undergoing breast cancer treatment.
Citation Format: Angarita FA, McCready DR, Cil T. Is breast reconstruction safe in women over 70? An analysis of the national surgical quality improvement program (NSQIP) database [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P5-16-01.