Routine Preoperative Nutritional Optimization Not Required in Patients Undergoing Breast Reconstruction

Overview

Journal Breast Care (Basel)

Publisher Karger

Date 2023 Jan 23

PMID 36684402

Authors

Matthew D Rich

Thomas J Sorenson

Abhinav Lamba

Christopher Hillard

Ashish Mahajan

Affiliations

Soon will be listed here.

Abstract

Purpose: There are no data describing the need for preoperative nutritional optimization in patients undergoing breast reconstruction surgery. The purpose of this research was to identify if preoperative breast reconstruction patients are grossly nutritionally deficient as defined by preoperative serum albumin and, thus, if routine preoperative nutrition screening and optimization is necessary in this patient population.

Methods: Adult patients who underwent breast reconstruction surgery between 2015 and 2019 were identified within the National Safety and Quality Improvement Program database. Variables of interest for this group of patients were collected, and comparisons were made for these variables between three different breast reconstruction modalities (implant-based reconstruction [IBR], expander-based reconstruction [EBR], and free tissue-based reconstruction [FTBR]) with χ and ANOVA statistical tests.

Results: A total of 14,509 patients were included. There was not a significant difference in preoperative serum albumin measurements between the three reconstruction modalities and mean measurements for the three reconstruction modalities were all within normal limits. Secondarily, when comparing groups, FTBR had higher incidence of superficial surgical site infection (SSI) (4.49% vs. 1.6% vs. 1.56%, respectively; < 0.00001), deep SSI (1.57% vs. 0.48% vs. 0.94%, respectively; < 0.00001), and wound disruption (2.16% vs. 0.78% vs. 0.94%, respectively; < 0.00001) than IBR and EBR.

Conclusion: Preoperative nutritional status was found to be grossly appropriate in a large population of breast reconstruction patients. Furthermore, the ordering of routine preoperative serum albumin is unnecessary and represents an extraneous healthcare cost that does not lead to improved outcomes in breast reconstruction. FTBR incurred the greatest risk of surgical complication independent of preoperative nutritional status.

References

Kashtan M, Graham D, Anandalwar S, Hills-Dunlap J, Rangel S . Variability, outcomes and cost associated with the use of parenteral nutrition in children with complicated appendicitis: A hospital-level propensity matched analysis. J Pediatr Surg. 2021; 56(12):2299-2304. DOI: 10.1016/j.jpedsurg.2021.03.005. View

Aydinli H, Aytac E, Remzi F, Bernstein M, Grucela A . Factors Associated with Short-Term Morbidity in Patients Undergoing Colon Resection for Crohn's Disease. J Gastrointest Surg. 2018; 22(8):1434-1441. DOI: 10.1007/s11605-018-3763-4. View

McKenna N, Bews K, Al-Refaie W, Colibaseanu D, Pemberton J, Cima R . Assessing Malnutrition Before Major Oncologic Surgery: One Size Does Not Fit All. J Am Coll Surg. 2020; 230(4):451-460. DOI: 10.1016/j.jamcollsurg.2019.12.034. View

Fu M, Buerba R, Grauer J . Preoperative Nutritional Status as an Adjunct Predictor of Major Postoperative Complications Following Anterior Cervical Discectomy and Fusion. Clin Spine Surg. 2014; 29(4):167-72. DOI: 10.1097/BSD.0000000000000181. View

McLeod D, Asti L, Mahida J, Deans K, Minneci P . Preoperative risk assessment in children undergoing major urologic surgery. J Pediatr Urol. 2015; 12(1):26.e1-7. DOI: 10.1016/j.jpurol.2015.04.044. View

Dindo D, Demartines N, Clavien P . Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004; 240(2):205-13. PMC: 1360123. DOI: 10.1097/01.sla.0000133083.54934.ae. View

Piquet M, Ozsahin M, Larpin I, Zouhair A, Coti P, Monney M . Early nutritional intervention in oropharyngeal cancer patients undergoing radiotherapy. Support Care Cancer. 2002; 10(6):502-4. DOI: 10.1007/s00520-002-0364-1. View

Ukogu C, Jacobs S, Ranson W, Somani S, Vargas L, Lee N . Preoperative Nutritional Status as a Risk Factor for Major Postoperative Complications Following Anterior Lumbar Interbody Fusion. Global Spine J. 2018; 8(7):662-667. PMC: 6232712. DOI: 10.1177/2192568218760540. View

Clavier J, Antoni D, Atlani D, Ben Abdelghani M, Schumacher C, Dufour P . Baseline nutritional status is prognostic factor after definitive radiochemotherapy for esophageal cancer. Dis Esophagus. 2012; 27(6):560-7. DOI: 10.1111/j.1442-2050.2012.01441.x. View

10.

Watson M, Trufan S, Benbow J, Gower N, Hill J, Salo J . Jejunostomy at the time of esophagectomy is associated with improved short-term perioperative outcomes: analysis of the NSQIP database. J Gastrointest Oncol. 2020; 11(2):421-430. PMC: 7212114. DOI: 10.21037/jgo.2020.02.06. View

11.

Awad M, Shuman A, Montero P, Palmer F, Shah J, Patel S . Accuracy of administrative and clinical registry data in reporting postoperative complications after surgery for oral cavity squamous cell carcinoma. Head Neck. 2014; 37(6):851-61. PMC: 4976499. DOI: 10.1002/hed.23682. View

12.

Hegazi R, Hustead D, Evans D . Preoperative standard oral nutrition supplements vs immunonutrition: results of a systematic review and meta-analysis. J Am Coll Surg. 2014; 219(5):1078-87. DOI: 10.1016/j.jamcollsurg.2014.06.016. View

13.

Gibbs J, Cull W, Henderson W, Daley J, Hur K, Khuri S . Preoperative serum albumin level as a predictor of operative mortality and morbidity: results from the National VA Surgical Risk Study. Arch Surg. 1999; 134(1):36-42. DOI: 10.1001/archsurg.134.1.36. View

14.

Rumberger L, Vittetoe D, Cathey L, Bennett H, Heidel R, Daley B . Improving Outcomes in Elective Colorectal Surgery: A Single-institution Retrospective Review. Am Surg. 2016; 82(4):325-30. View

15.

Xu J, Sun X, Xin Q, Cheng Y, Zhan Z, Zhang J . Effect of immunonutrition on colorectal cancer patients undergoing surgery: a meta-analysis. Int J Colorectal Dis. 2018; 33(3):273-283. PMC: 5816768. DOI: 10.1007/s00384-017-2958-6. View

16.

Odelli C, Burgess D, Bateman L, Hughes A, Ackland S, Gillies J . Nutrition support improves patient outcomes, treatment tolerance and admission characteristics in oesophageal cancer. Clin Oncol (R Coll Radiol). 2005; 17(8):639-45. DOI: 10.1016/j.clon.2005.03.015. View

17.

Ladd M, Garcia A, Leeds I, Haney C, Oliva-Hemker M, Alaish S . Malnutrition increases the risk of 30-day complications after surgery in pediatric patients with Crohn disease. J Pediatr Surg. 2018; 53(11):2336-2345. PMC: 8841062. DOI: 10.1016/j.jpedsurg.2018.04.026. View

18.

Haskins I, Baginsky M, Amdur R, Agarwal S . Preoperative hypoalbuminemia is associated with worse outcomes in colon cancer patients. Clin Nutr. 2016; 36(5):1333-1338. DOI: 10.1016/j.clnu.2016.08.023. View

19.

Soufi M, DePeralta D, Simpson R, Flick K, Yip-Schneider M, Schmidt 2nd C . Novel Preoperative Patient-centered Surgical Wellness Program Impacts Length of Stay Following Pancreatectomy. Anticancer Res. 2021; 41(4):1895-1901. DOI: 10.21873/anticanres.14955. View

20.

Jiang X, Chen X, Wang X, Chen Y, Xie Q, Peng J . Optimal Nutrition Formulas for Patients Undergoing Surgery for Colorectal Cancer: A Bayesian Network Analysis. Nutr Cancer. 2020; 73(5):775-784. DOI: 10.1080/01635581.2020.1770812. View