Analysis of Perioperative Risk Factors for Complications Following Modified Radical Mastectomy- A Longitudinal Study

Abstract

Introduction: Modern therapy for the breast cancer has evolved to include both surgical and systemic therapy. The Modified Radical Mastectomy (MRM) is the standard treatment option for most of the patients with breast cancer. Early complications are defined here as complications occurring within 30 days after surgery. The initial complications following MRM includes wound infections, seromas, chronic pain, flap necrosis and haematomas. Aim: To study the frequency of occurrence of outcomes such as, seroma, haematoma, flap necrosis, Surgical Site Infection (SSI) following MRM and to associate the outcomes with the clinical, demographic, intraoperative and postoperative factors. Materials and Methods: The present study was a single centre longitudinal cohort study with sample size of 72. Patients who are admitted for MRM for carcinoma breast between January 2019 to January 2020 in Department of General Surgery, ESIC MC & PGIMSR, Rajajinagar, Bengaluru, Karnataka, India, were taken for study after considering the inclusion and exclusion criteria. The data of risk factors collected were entered into a proforma. After surgery they were observed postoperatively for early complications. They were followed-up for a period of one month. Information was entered in Statistical Package for the Social Sciences (SPSS) software. Descriptive statistics comprising of mean, average, standard deviation, proportion, and percentage were used. Comparison of continuous data was done by Student's t-test and categorical variables were compared using Chi-square test. Variables with p-value <0.05 were considered as significant risk factor. Results: Out of the 72 patients, who underwent MRM 27 (37.5%) developed seroma, 6 patients (8.3%) developed SSI and 9 patients (12.5%) developed flap necrosis. There was significant association between Seroma Formation (SF) and higher age (p=0.026), higher BMI (p=0.001), hypertension (p=0.004) and drain volume on day 1 (p<0.001). There was significant association between SSI and Diabetes Mellitus (DM) (p=0.002), prolonged duration of drain (p=0.03). There was significant association between flap necrosis and DM (p=0.003). Conclusion: The incidence of seroma was higher in older, hypertensive and in more obese patients. It was decreased was decreased by flap fixation under muscles. The incidence of SSI and flap necrosis was higher among diabetic patients. Optimisation of glycaemia will help in reducing both.

Keywords

• flap necrosis
• seroma
• surgical site infection