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Differential impact of non-insulin-dependent diabetes mellitus and insulin-dependent diabetes mellitus on breast reconstruction outcomes

  • Epidemiology
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Abstract

While the comparative safety of breast reconstruction in diabetic patients has been previously studied, we examine the differential effects of insulin and non-insulin-dependence on surgical/medical outcomes. Patients undergoing implant/expander or autologous breast reconstruction were extracted from the National Surgical Quality Improvement Program 2005–2012 database. Preoperative and postoperative variables were analyzed using chi-square and Student’s t test as appropriate. Multivariate regression modeling was used to evaluate whether non-insulin-dependent diabetes mellitus (NIDDM) or insulin-dependent diabetes mellitus (IDDM) is independently associated with adverse 30-day events following breast reconstruction. Of 29,736 patients meeting inclusion criteria, 23,042 (77.5 %) underwent implant/expander reconstructions, of which 815 had NIDDM and 283 had IDDM. Of the 6,694 (22.5 %) patients who underwent autologous reconstructions, 286 had NIDDM and 94 had IDDM. Rates of overall and surgical complications significantly differed among non-diabetic, NIDDM and IDDM patients in both the implant/expander and autologous cohorts on univariate analysis. After multivariate analysis, NIDDM was significantly associated with surgical complications (OR 1.511); IDDM was significantly associated with medical (OR 1.815) and overall complications (OR 1.852); and any type of diabetes was significantly associated with surgical (OR 1.58) and overall (OR 1.361) complications after autologous reconstruction. Diabetes of any type was not associated with any type of complication after implant/expander reconstruction. In this large, multi-institutional study, diabetes mellitus was significantly associated with adverse outcomes after autologous, but not implant-based breast reconstruction. The multivariate analysis in this study adds granularity to the differential effects of NIDDM and IDDM on complication risk.

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Acknowledgments

This particular research received no internal or external grant funding.

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical standard

De-identified patient information is freely available to all institutional members who comply with the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) Data Use Agreement. The Data Use Agreement implements the protections afforded by the Health Insurance Portability and Accountability Act of 1996 and the ACS-NSQIP Hospital Participation Agreement, and conforms to the Declaration of Helsinki.

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Authors and Affiliations

  1. Department of Plastic and Reconstructive Surgery, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA

    Charles Qin, Elbert Vaca, Francis Lovecchio & John Y. S. Kim

  2. Division of Plastic, Reconstructive, and Hand Surgery, Baptist Memorial Healthcare, Memphis, TN, USA

    Jon P. Ver Halen

  3. Vanderbilt Ingram Cancer Center, Nashville, TN, USA

    Jon P. Ver Halen

  4. St. Jude Children’s Research Hospital, Memphis, TN, USA

    Jon P. Ver Halen

  5. Division of Breast Surgery, Department of Surgery, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA

    Nora M. Hansen

  6. Division of Plastic and Reconstructive Surgery, Northwestern University, Feinberg School of Medicine, 675 North St. Clair Street, Galter Suite 19-250, Chicago, IL, 60611, USA

    John Y. S. Kim

Authors
  1. Charles Qin
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  2. Elbert Vaca
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  3. Francis Lovecchio
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  4. Jon P. Ver Halen
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  5. Nora M. Hansen
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  6. John Y. S. Kim
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Corresponding author

Correspondence to John Y. S. Kim.

Additional information

The NSQIP and the hospitals participating in the NSQIP are the source of the data used herein; they have not been verified and are not responsible for the statistical validity of the data analysis, or the conclusions derived by the authors of this study.

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Qin, C., Vaca, E., Lovecchio, F. et al. Differential impact of non-insulin-dependent diabetes mellitus and insulin-dependent diabetes mellitus on breast reconstruction outcomes. Breast Cancer Res Treat 146, 429–438 (2014). https://doi.org/10.1007/s10549-014-3024-5

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  • DOI: https://doi.org/10.1007/s10549-014-3024-5

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