Identifying modifiable perioperative risk factors for wound healing complications after immediate autologous breast reconstruction.

BACKGROUND

Autologous breast reconstruction (ABR) offers superior aesthetics but carries significant risks of wound healing complications. We aimed to identify modifiable perioperative factors associated with these complications to optimize surgical outcomes.

METHODS

We analyzed the ACS-NSQIP database (2011-2022) for patients undergoing immediate ABR. Multivariable regression identified independent associations with 30-day wound complications.

RESULTS

Among 7489 patients, wound complications occurred 634 times: superficial surgical site infection (SSSI, n = 358), deep incisional infection (DII, n = 87), dehiscence (n = 126), and organ space infection (OSI, n = 63). Higher BMI was significantly associated with all wound complication types (OR 1.1; p ≤ 0.001). Smoking was independently associated with SSSI (OR 1.6; p = 0.024) and DII (OR 2.3; p = 0.033). Diabetes (OR 3.3; p < 0.001) and dyspnea (OR 3.6; p = 0.022) were significantly associated with increased OSI risk. Wound class >1 was associated with SSSI (OR 1.5) and DII (OR 2.4).

CONCLUSION

BMI, smoking, and diabetes are critical and potentially modifiable risk factors associated with wound complications in ABR. Preoperative optimization could reduce these adverse events and improve reconstructive success.