Postoperative Outcomes in Breast Surgery: Importance of Preoperative Risk Stratification

Abstract

INTRODUCTION: Preoperative risk stratiication (ASA) assesses the relative hazards of a surgical scenario, regardless of procedural type. It is known that breast surgeries have low index of complications, however, the morbi-mortality determined by the preoperative risk stratification in this subset is poorly studied. The aim of this study was to determine the importance of preoperative risk stratification to provide informations about the postoperative outcomes in patients submmited to breast surgery. METHODS: A total of 1.563 patients (56.5+/- 12.5 yrs) undergoing breast surgery with general anesthesia were retrospectively studied. All patients have preoperative risk stratification (ASA) and in-hospital evolution documented. Patient age, comorbidities, prior chemotherapy (QT), prior radiotherapy (RXT), type of procedure, and duration of surgery were evaluated for potential influence. Adverse autcomes were defined as extend in-hospital stay or death. RESULTS: The study population was stratified as follows: ASA I, 679 (43.4%); ASA II, 808 (51.7%); ASA III, 70 (4.5%); and ASA IV, 6 (0.4%). There were two deaths (0.13%) and 42 complications (2.69%). The average time of surgery was 2.52 ± 0.85 hrs (0.75-7.5 hrs). In-hospital complications occurred in 1.3% CI=1.2 - 1.4, OR=1.00 (ASA I), 3.3% CI=3.1 - 3.6, OR=2.56 (ASA II), 10.0% CI=7.9 - 12.1, OR=8.22 (ASA III) and 16.7% CI=5.6 - 27.8, OR=14.82 (ASA IV) (p=0.001). Among the variables analyzed - comorbidities (p=0.126), QT (p=0.775), RXT (p=0.999), type of procedure (p=0.110), and duration of surgery (p=0.130) - only age (p=0.001) showed a significant association with patient outcome. DISCUSSION: In the association between inherent risk to patient (ASA) and the inherent risk to the procedure (surgery) we would have a more refined assessment of the postoperative morbi-mortality. That was the purpose of this study. The most relevant finding was a linear increase in the stratified morbi-mortality by the preoperative clinical evaluation in this subgroup of patients, where it was expected a low index of complications, that could mask or even to question the importance of the preoperative risk stratification. CONCLUSION: The preoperative risk stratification has been shown associated with the postoperative outcome in patients underwent breast surgery, suggesting that even in low risk subgroup, the stratification could provide relevant information in relation to morbi-mortality postoperative.