{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,8]],"date-time":"2026-03-08T11:36:35Z","timestamp":1772969795111,"version":"3.50.1"},"reference-count":16,"publisher":"Georg Thieme Verlag KG","issue":"03","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Reconstr Microsurg"],"published-print":{"date-parts":[[2023,3]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>\n          Background\u2003Postmastectomy breast cancer lymphedema poses an important health threat. Historically, physical therapy was the exclusive treatment option. More recently, lymphedema surgery has revolutionized care. As a first-in-kind, multicenter report, the postmastectomy breast cancer patients' risk factors associated with postlymphedema ablative surgical outcomes were documented.<\/jats:p><jats:p>\n          Methods\u2003Using the New York Statewide Planning and Research Cooperative System database from 2010 to 2018, multivariable models identified the postmastectomy breast cancer lymphedema surgical patients' characteristics associated with major adverse outcomes and mortality.<\/jats:p><jats:p>\n          Results\u2003Of 65,543 postmastectomy breast cancer patients, 1,052 lymphedema surgical procedures were performed including 393 (37.4%) direct excisions and 659 (63.6%) liposuctions. Direct excision and liposuction surgical patients had median ages of 58 and 52 years, respectfully (p\u2009&lt;\u20090.001). Although a 30-day operative mortality was rare (0.3%, all direct excisions), major adverse outcomes occurred in 154 patients (28.5% direct excision; 6.4% liposuction; p\u2009&lt;\u20090.0001). Multivariable clinical outcomes model identified that patients with higher Elixhauser's score, renal disease, emergent admissions, and direct excision surgery had higher incidences of adverse outcomes (all p\u2009&lt;\u20090.01). For those patients with 30-day readmissions (n\u2009=\u200960), they were more likely to have undergone direct excision versus liposuction (12.5 vs. 1.7%; p\u2009&lt;\u20090.0001). The important risk factors predictive of future cellulitis\/lymphangitis development included diabetes mellitus, Medicaid insurance, renal disease, prior cellulitis\/lymphangitis, chronic obstructive pulmonary disease (COPD), and chronic steroid use (all p\u2009&lt;\u20090.01).<\/jats:p><jats:p>\n          Conclusion\u2003Lymphedema surgery carries a favorable risk profile, but better understanding the \u201chigh-risk\u201d patients is critical. As this new era of lymphedema surgery progresses, evaluating the characteristics for adverse postoperative outcomes is an important step in our evolution of knowledge.<\/jats:p>","DOI":"10.1055\/s-0042-1755258","type":"journal-article","created":{"date-parts":[[2022,9,26]],"date-time":"2022-09-26T22:59:44Z","timestamp":1664233184000},"page":"214-220","source":"Crossref","is-referenced-by-count":3,"title":["Risk Factors Associated with Adverse Outcomes after Ablative Surgery for Lymphedema"],"prefix":"10.1055","volume":"39","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8364-9475","authenticated-orcid":false,"given":"Annet S.","family":"Kuruvilla","sequence":"additional","affiliation":[{"name":"Division of Plastic Surgery, Department of Surgery, Stony Brook University, Renaissance School of Medicine, Stony Brook, New York"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Annie Laurie W.","family":"Shroyer","sequence":"additional","affiliation":[{"name":"Division of Plastic Surgery, Department of Surgery, Stony Brook University, Renaissance School of Medicine, Stony Brook, New York"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xiaoning","family":"Li","sequence":"additional","affiliation":[{"name":"Division of Plastic Surgery, Department of Surgery, Stony Brook University, Renaissance School of Medicine, Stony Brook, New York"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jie","family":"Yang","sequence":"additional","affiliation":[{"name":"Division of Plastic Surgery, Department of Surgery, Stony Brook University, Renaissance School of Medicine, Stony Brook, New York"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sagar R.","family":"Mulay","sequence":"additional","affiliation":[{"name":"Division of Plastic Surgery, Department of Surgery, Stony Brook University, Renaissance School of Medicine, Stony Brook, New York"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sohaib M.","family":"Agha","sequence":"additional","affiliation":[{"name":"Division of Plastic Surgery, Department of Surgery, Stony Brook University, Renaissance School of Medicine, Stony Brook, New York"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Raymond M.","family":"Bellis","sequence":"additional","affiliation":[{"name":"Division of Plastic Surgery, Department of Surgery, Stony Brook University, Renaissance School of Medicine, Stony Brook, New York"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Harmehar K.","family":"Kohli","sequence":"additional","affiliation":[{"name":"Division of Plastic Surgery, Department of Surgery, Stony Brook University, Renaissance School of Medicine, Stony Brook, New York"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Henry J.","family":"Tannous","sequence":"additional","affiliation":[{"name":"Division of Plastic Surgery, Department of Surgery, Stony Brook University, Renaissance School of Medicine, Stony Brook, New York"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aleksandra","family":"Krajewski","sequence":"additional","affiliation":[{"name":"Division of Plastic Surgery, Department of Surgery, Stony Brook University, Renaissance School of Medicine, Stony Brook, New York"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"194","published-online":{"date-parts":[[2022,9,26]]},"reference":[{"issue":"02","key":"ref1","doi-asserted-by":"crossref","first-page":"178","DOI":"10.1097\/COC.0000000000000355","article-title":"A review of treatment for breast cancer-related lymphedema: paradigms for clinical practice","volume":"41","author":"T D Smile","year":"2018","journal-title":"Am J Clin Oncol"},{"issue":"02","key":"ref2","doi-asserted-by":"crossref","first-page":"848","DOI":"10.4081\/monaldi.2017.848","article-title":"Current multivariate risk scores in patients undergoing non-cardiac surgery","volume":"87","author":"G F Mureddu","year":"2017","journal-title":"Monaldi Arch Chest Dis"},{"issue":"12","key":"ref3","doi-asserted-by":"crossref","first-page":"1367","DOI":"10.1016\/j.jpain.2018.06.002","article-title":"Persistent post-mastectomy pain: risk factors and current approaches to treatment","volume":"19","author":"R C Tait","year":"2018","journal-title":"J Pain"},{"issue":"03","key":"ref4","doi-asserted-by":"crossref","first-page":"738","DOI":"10.1097\/PRS.0000000000005993","article-title":"Surgical treatment of lymphedema","volume":"144","author":"M V Schaverien","year":"2019","journal-title":"Plast Reconstr Surg"},{"issue":"01","key":"ref5","doi-asserted-by":"crossref","first-page":"199","DOI":"10.1097\/PRS.0000000000007507","article-title":"Changing the paradigm: lymphovenous anastomosis in advanced stage lower extremity lymphedema","volume":"147","author":"H G Cha","year":"2021","journal-title":"Plast Reconstr Surg"},{"issue":"01","key":"ref6","first-page":"56","article-title":"Liposuction in lymphedema treatment","volume":"32","author":"H Brorson","year":"2016","journal-title":"J Reconstr Microsurg"},{"issue":"03","key":"ref7","doi-asserted-by":"crossref","first-page":"337","DOI":"10.1097\/SAP.0000000000000597","article-title":"Operative treatment of lymphedema using suction-assisted lipectomy","volume":"77","author":"A K Greene","year":"2016","journal-title":"Ann Plast Surg"},{"issue":"10","key":"ref8","first-page":"e5913","article-title":"Lipoaspiration for the treatment of lower limb lymphedema: a comprehensive systematic review","volume":"11","author":"A J Forte","year":"2019","journal-title":"Cureus"},{"issue":"12","key":"ref9","doi-asserted-by":"crossref","first-page":"1495","DOI":"10.1016\/j.ijsu.2014.07.013","article-title":"The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies","volume":"12","author":"E von Elm","year":"2014","journal-title":"Int J Surg"},{"issue":"05","key":"ref10","doi-asserted-by":"crossref","first-page":"373","DOI":"10.1016\/0021-9681(87)90171-8","article-title":"A new method of classifying prognostic comorbidity in longitudinal studies: development and validation","volume":"40","author":"M E Charlson","year":"1987","journal-title":"J Chronic Dis"},{"issue":"01","key":"ref11","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1097\/00005650-199801000-00004","article-title":"Comorbidity measures for use with administrative data","volume":"36","author":"A Elixhauser","year":"1998","journal-title":"Med Care"},{"issue":"07","key":"ref12","doi-asserted-by":"crossref","first-page":"e2861","DOI":"10.1097\/MD.0000000000002861","article-title":"Comparison of elixhauser and charlson methods for predicting oral cancer survival","volume":"95","author":"H J Chang","year":"2016","journal-title":"Medicine (Baltimore)"},{"issue":"11","key":"ref13","doi-asserted-by":"crossref","first-page":"1130","DOI":"10.1097\/01.mlr.0000182534.19832.83","article-title":"Coding algorithms for defining comorbidities in ICD-9-CM and ICD-10 administrative data","volume":"43","author":"H Quan","year":"2005","journal-title":"Med Care"},{"key":"ref14","doi-asserted-by":"crossref","DOI":"10.1007\/978-1-4614-6849-3","volume-title":"Applied Predictive Modeling","author":"M Kuhn","year":"2013"},{"key":"ref15","doi-asserted-by":"crossref","first-page":"g2215","DOI":"10.1136\/bmj.g2215","article-title":"Trap of trends to statistical significance: likelihood of near significant P value becoming more significant with extra data","volume":"348","author":"J Wood","year":"2014","journal-title":"BMJ"},{"issue":"06","key":"ref16","doi-asserted-by":"crossref","first-page":"975e","DOI":"10.1097\/PRS.0000000000006223","article-title":"Developing a lymphatic surgery program: a first-year review","volume":"144","author":"A R Johnson","year":"2019","journal-title":"Plast Reconstr Surg"}],"container-title":["Journal of Reconstructive Microsurgery"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/s-0042-1755258.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,2,23]],"date-time":"2023-02-23T00:20:00Z","timestamp":1677111600000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/s-0042-1755258"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,9,26]]},"references-count":16,"journal-issue":{"issue":"03","published-online":{"date-parts":[[2023,2,22]]},"published-print":{"date-parts":[[2023,3]]}},"URL":"https:\/\/doi.org\/10.1055\/s-0042-1755258","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["0743-684X","1098-8947"],"issn-type":[{"value":"0743-684X","type":"print"},{"value":"1098-8947","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,9,26]]}}}