The Baltodano Breast Reduction Score: A Nationwide, Multi-Institutional, Validated Approach to Reducing Surgical-Site Morbidity

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Abstract

Background:

Breast reduction remains associated with significantly higher rates of overall morbidity, superficial surgical-site infections, and wound disruptions. The authors developed a validated risk model to identify patients at higher risk for postoperative surgical-site morbidity after breast reduction.

Methods:

A retrospective review was performed of all women undergoing breast reduction from the American College of Surgeons National Surgical Quality Improvement Program 2005 to 2012 data. Surgical-site morbidity included surgical-site infection and wound disruption events. Stepwise multivariable logistic regression identified risk factors associated with surgical-site morbidity. The model was validated using bootstrap replications (n = 100) and the Hosmer-Lemeshow test, and converted into the Baltodano breast reduction score, a clinical risk tool predictive of surgical-site morbidity.

Results:

The authors identified 7068 breast reductions. Rate of 30-day surgical-site morbidity was 3.98 percent. Independent risk factors included resident participation (OR, 1.5; 95 percent CI, 1.1 to 2.0; p = 0.004), body mass index (for every 5-unit increase: OR, 1.3; 95 percent CI, 1.1 to 1.4; p < 0.001), smoking (OR, 1.6; 95 percent CI, 1.1 to 2.4; p = 0.014), steroid use (OR, 3.5; 95 percent CI, 1.4 to 8.4; p = 0.006), and operation in the third quarter of the year (OR, 1.5; 95 percent CI, 1.1 to 1.9; p = 0.014). The factors were integrated into the Baltodano score, ranging from 0 to 16. The predicted probability of surgical-site morbidity associated with each risk score was estimated. Predicted and observed risks of surgical-site morbidity were highly comparable.

Conclusions:

The authors present the Baltodano breast reduction score, a validated risk-stratification tool for predicting 30-day surgical-site morbidity following breast reduction using data that are readily available to the clinician. This may allow targeted screening and intervention in high-risk patients, better counseling, selective resident participation, and ultimately a decrease in overall health care costs.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Risk, III.

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