Incidence, risk factors, and outcomes of postoperative pulmonary complications after mastectomy and immediate breast reconstruction

This is the authors' abstract. We don't add key points for this paper.

Postoperative pulmonary complications (PPCs) after mastectomy with immediate breast reconstruction (IBR) have been insufficiently characterized. This study evaluated the incidence, risk factors, and clinical outcomes of PPCs in females undergoing total mastectomy. Women with breast cancer, ductal carcinoma in situ, lobular carcinoma in situ, or documented increased breast cancer risk due to genetic susceptibility or family history who underwent total mastectomy with IBR between 2016 and 2022 were identified in the US National Readmission Database (NRD) using ICD-10 diagnostic and procedure codes. Patients with distant metastasis, emergent procedures, or missing key information (e.g., sex, main endpoints, and sample weights) were excluded. PPCs included respiratory infection, respiratory failure, pleural effusion, atelectasis, pneumothorax, bronchospasm, aspiration pneumonitis. Outcomes and risk factors associated with PPCs were evaluated using multivariable analyses. Among 36,881 patients, representing 62,319 hospitalizations nationally, PPCs were identified in 2.3% of patients. After adjustments, PPCs were associated with longer hospital stays (adjusted beta = 1.53 days; 95% CI, 1.19–1.87), higher odds of major systemic complications (adjusted odds ratio [aOR] = 8.19; 95% CI, 5.48–12.22), 30- and 90-day unplanned readmission (aOR = 1.58; 95% CI, 1.19–2.09; aOR = 1.35; 95% CI, 1.06–1.73, respectively). Increased PPC risk was associated with autologous reconstruction (aOR = 4.31; 95% CI, 3.57–5.21) and weekend admission (aOR = 2.35; 95% CI, 1.30–4.25), whereas lower PPC risk was associated with higher household income (aOR = 0.77; 95% CI, 0.60–0.98) and higher hospital procedure volume (aOR = 0.67; 95% CI, 0.55–0.82). PPCs occurred in 2.3% of women undergoing mastectomy with IBR and were associated with greater systemic morbidity, prolonged hospitalization, and increased 30- and 90-day unplanned readmissions. Autologous reconstruction, weekend admission, and cardiopulmonary and metabolic comorbidities were associated with increased PPC risk, whereas higher hospital procedural volume was associated with reduced risk.