57. Rising Complication Rates in Immediate Breast Reconstruction: A 17-year Analysis of 103,428 Cases

PURPOSE: Breast reconstruction following mastectomy is a common procedure that has evolved significantly over the years. Understanding trends in reconstruction type, patient risk factors, and complication rates is essential to optimizing outcomes. This study aims to evaluate temporal trends in breast reconstruction, patient characteristics, and associated 30-day complications from 2005 to 2022. METHODS: Data from a cohort of 103,428 patients undergoing immediate breast reconstruction between 2005 and 2022 were analyzed from the American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP). Patient demographics, reconstruction type (autologous vs. implant-based), ASA classification, and 30-day postoperative complication rates were extracted. A temporal analysis was performed using logistic regression to assess the association between year and the risk of complications. RESULTS: The number of immediate breast reconstructions increased significantly from 295 (0.29%) in 2005 to 8,548 (8.26%) in 2021, with a slight decline to 8,125 (7.86%) in 2022. The majority of reconstructions were implant-based (85.95%, 88,894), while autologous reconstructions accounted for 16.93% (17,505). Most patients were classified as ASA Class II (67.12%, 69,426), followed by Class III (25.21%, 26,075), and Class I (7.28%, 7,534). The overall 30-day complication rate was 5.82% (8,048). The five most prevalent complication rates were as follows: superficial SSI at 2.26% (2,337), blood transfusion at 1.16% (1,200), organ space SSI at 1.24% (1,283), deep SSI at 0.98% (1,014), and wound disruption at 0.79% (817). Logistic regression showed a significant association between year and overall complications, with a regression coefficient (β) of 0.042 (95% CI: 0.036-0.047, p<0.001). Year was also significantly associated with specific complications, including superficial SSI (β = 0.064, 95% CI: 0.053-0.074, p<0.001), blood transfusion (β = 0.027, 95% CI: 0.016-0.038, p<0.001), and organ space SSI (β = 0.107, 95% CI: 0.094-0.121, p<0.001). Conversely, deep SSI decreased over time (β = -0.043, 95% CI: -0.058 to -0.028, p<0.001), while wound disruption was positively associated with year (β = 0.051, 95% CI: 0.035-0.067, p<0.001). CONCLUSION: Breast reconstruction rates have increased significantly over the past two decades, with implant-based reconstruction as the predominant method. While the overall 30-day complication rate remains low, it has more than doubled over the study period, largely driven by an increase in superficial surgical site infections (SSI). These findings emphasize the urgent need for future studies to explore and address the rising complication rates, particularly superficial SSI, in immediate breast reconstruction surgery.