Hypertension’s hidden hand? A retrospective ACS-NSQIP analysis of medically treated hypertension and outcomes after autologous breast reconstruction

Abstract Background Hypertension affects nearly a third of the adult global population and is associated with increased risks of postoperative complications across various surgeries. However, its specific impact on outcomes of immediate autologous breast reconstruction (ABR) after mastectomy has not yet been thoroughly studied. Methods We filtered the American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) to identify patients who underwent immediate ABR between 2008 and 2022. Patients were dichotomized into those medically treated for hypertension (MedHyp) and those not (NoMedHyp). Propensity score matching (PSM) was performed to adjust for baseline differences. Thirty-day postoperative outcomes, including operative time, length of hospital stay, and complications, were analyzed using linear and logistic regression models. Results A total of 9,041 patients were included, 2,431 (26.9%) in the MedHyp group (mean age: 57.3 ± 9.1 years; mean BMI: 31.0 ± 6.3 kg/m²) and 6,610 (73.1%) in the NoMedHyp (mean age: 50.9 ± 9.3 years; mean BMI: 28.5 ± 6.0 kg/m²). The overall complication rate was 24.9% (n = 2,249), with 1,545 (23.4%) complications in MedHyp patients and 704 (29.0%) in NoMedHyp patients. PSM resulted in well-balanced groups across key covariates. Based on PSM, MedHyp was associated with a significantly higher risk of any postoperative complication (OR 1.20, p = 0.04) and reoperation (OR 1.29, p = 0.04). We did not identify any significant increases for unplanned readmission (OR 1.17, p = 0.24), surgical complications (OR 1.16, p = 0.14), or medical complications (OR 1.11, p = 0.24) in hypertensive patients. In addition, no significant differences were observed in operative time (p = 0.14) or total hospital length of stay (p = 0.72) between the groups. Conclusions MedHyp is a significant independent risk factor for postoperative complications following immediate ABR. Our findings underscore the importance of blood pressure management prior to ABR and call for collaborative, interdisciplinary efforts to minimize the perioperative risk in hypertensive patients. Level of evidence Level III, risk / prognostic study.