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Meta-Analysis
. 2016 Jun;95(26):e4072.
doi: 10.1097/MD.0000000000004072.

Is obesity a predisposing factor for free flap failure and complications? Comparison between breast and nonbreast reconstruction: Systematic review and meta-analysis

Jin Yong Shin  1 , Si-Gyun Roh, Nae-Ho Lee, Kyung-Moo Yang
Affiliations
Meta-Analysis

Is obesity a predisposing factor for free flap failure and complications? Comparison between breast and nonbreast reconstruction: Systematic review and meta-analysis

Jin Yong Shin et al. Medicine (Baltimore). 2016 Jun.

Erratum in

Abstract

Obesity is a risk factor for postoperative morbidity in breast reconstruction. Although existing studies about nonbreast reconstruction are limited, previous research has demonstrated that obesity is not an important factor in poor outcomes in nonbreast reconstruction. Our study evaluates the effects of obesity on postoperative morbidity in nonbreast reconstruction in comparison to breast reconstruction. A systematic literature review and meta-analysis was performed using Medline, EMBASE, and Cochrane databases. Obesity was extracted for predictor variables and partial, total loss of flap, and complication were extracted for outcome variables. Subgroup analyses were performed according to reconstruction site. The Newcastle-Ottawa scale (NOS) was used to assess the quality of the studies, and the Cochrane risk of bias tool was used. Publication bias was evaluated using funnel plots. The search strategy identified 944 publications. After screening, 19 articles were selected for review. Partial flap loss, total flap loss, and complications in breast reconstruction occurred significantly more often in obese patients in comparison to nonobese patients (OR = 2.479, P = 0.021 for partial loss, OR = 3.083, P = 0.002 for total loss, OR = 2.666, P = 0.001 for complications). In contrast, partial flap loss, total flap loss, and complications in nonbreast reconstruction were not significantly different in obese patients in comparison to nonobese patients (OR = 0.786, P = 0.629 for partial loss, OR = 0.960, P = 0.961 for total loss, and OR = 1.009, P = 0.536 for complications). In contrast to the relationship between obesity and poor outcomes in breast reconstruction, our study suggests the obesity is not a predisposing factor for poor outcomes in nonbreast reconstruction. Long-term studies are needed to confirm these findings.

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Conflict of interest statement

The authors have no conflicts of interest to disclose.

Figures

Figure 1
Figure 1
Flow diagram for the identification of relevant studies.
Figure 2
Figure 2
Forest plot comparing the incidence of partial flap loss between obese and nonobese patients in overall free flap surgeries.
Figure 3
Figure 3
Forest plot comparing the incidence of total flap loss between obese and nonobese patients in overall free flap surgeries.
Figure 4
Figure 4
Forest plot comparing the incidence of complications between obese and nonobese patients in overall free flap surgeries.
Figure 5
Figure 5
Forest plot comparing the incidence of partial flap loss between obese and nonobese patients in breast reconstruction.
Figure 6
Figure 6
Forest plot comparing the incidence of total flap loss between obese and nonobese patients in breast reconstruction.
Figure 7
Figure 7
Forest plot comparing the incidence of complications between obese and nonobese patients in breast reconstruction.
Figure 8
Figure 8
Forest plot comparing the incidence of partial flap loss between obese and nonobese patients in nonbreast reconstruction.
Figure 9
Figure 9
Forest plot comparing the incidence of total flap loss between obese and nonobese patients in nonbreast reconstruction.
Figure 10
Figure 10
Forest plot comparing the incidence of complications between obese and nonobese patients in nonbreast reconstruction.
Figure 11
Figure 11
Funnel plot of direct-comparison meta-analysis for total flap loss in breast reconstruction.
Figure 12
Figure 12
Funnel plot of direct-comparison meta-analysis for complications in breast reconstruction.
Figure 13
Figure 13
Funnel plot of direct-comparison meta-analysis for complications in nonbreast reconstruction.
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