Does the Indication for Breast Surgery Impact Surgical Outcomes? A Contemporary Analysis of the ACS-NSQIP Database

Background. There is limited data about whether perioperative outcomes differ based on the indication for breast surgery. Herein we aim to assess if breast surgery for prophylaxis, compared to that for malignancy, impacts surgical outcomes. Methods. All women who underwent simple or subcutaneous mastectomy were identified from the 2007-2012 ACS-NSQIP database. Patients were identified by their ICD-9 codes and categorized into two groups. Group 1 consisted of patients diagnosed with breast cancer or carcinoma in situ; group 2 consisted of patients diagnosed with a genetic predisposition to malignant neoplasm of the breast (i.e., BRCA mutation). Demographic and preoperative variables were compared between groups and outcome variables. Outcome variables were analyzed using age- and operative time-adjusted logistic regression models. Results. 30,803 patients were identified. Group 1 consisted of 30,644 (99.5%) patients diagnosed with malignancy; group 2 consisted of 159 (0.5%) who underwent prophylactic surgery. In univariate analyses, those undergoing prophylactic surgery were significantly younger (p \u3c 0.01). There were no other preoperative differences between groups. When adjusted, the prophylactic group demonstrated a greater risk of DVT (p = 0.03). There were no differences in mortality, superficial/deep/organ space infections, UTI, wound dehiscence, or MI. Conclusion. In this analysis of a national cohort of breast surgery patients, those undergoing prophylactic surgery due to a genetic predisposition had a greater risk of perioperative DVT, compared to those who underwent surgery for a diagnosis of malignancy. This data may allow for improved perioperative management of patients to prevent DVT development and their devastating consequences

The Gift:Transforming Lives through Organ Donation

It is my great pleasure to introduce this comic. Our project originated from an honest conversation with my friend and colleague Prof Chris Murray: how to communicate complex issues surrounding the issue of organ donation? Over the last seven years I have had the honour of being an ambassador for the Organ Donation campaign by telling my son, Andrew’s, story.Through my role as an Organ Donation ambassador I meet courageous and selfless people. Some are in desperate need of hope, some are in the position to provide hope, and those who, through their professionalism and dedication, transform lives.Our sincere thanks for the support of the following organisations: University of Dundee; the NHS Blood and Transplant Specialist Nurses in Organ Donation; Dundee Comics Creative Space; Good Life, Good Death, Good Grief, and the Organ Donation Comics team. it is only through their support that this projectcame to fruition.In the following pages we share heartfelt stories and life experiences related to organ donation. By doing so we hope to bring awareness to a wider audience and prompt honest conversations about organ donation.Finally, I would like thank my sons Andrew and Stuart for warming my heart. Through tears and laughter we present to you… The Gift