HRT Not Linked to Most 90-Day Complications After Breast Reconstruction

A propensity-matched TriNetX cohort study compared 3,750 postmenopausal patients using hormone replacement therapy (HRT) with 3,750 matched nonusers after breast surgery and reconstruction. HRT use was not significantly associated with postoperative mortality, venous thromboembolism or wound-healing complications; revision rates were higher among HRT users undergoing autologous reconstruction.

Matched cohorts included 3,750 HRT users and 3,750 nonusers.
HRT was not linked to significant differences in key 90-day complications.
One-year revision rates were higher after autologous reconstruction among HRT users.
Observational database findings require prospective validation.

Researchers used the TriNetX database to compare postoperative outcomes in postmenopausal patients with and without systemic HRT use in the year before breast reconstruction. Mastectomy and reconstruction procedures were identified through procedure codes, and HRT exposure through diagnosis and medication codes. The initial cohorts included 3,750 HRT users and 75,503 nonusers; propensity matching produced two groups of 3,750. Outcomes were assessed within 90 days, with revision rates also reported at one year for autologous reconstruction.

After matching, HRT use was not significantly associated with postoperative mortality, venous thromboembolism or wound-healing complications, including infection and wound dehiscence. These outcomes were described as comparably low across surgery types. Among patients who underwent autologous reconstruction, one-year revision rates were higher in the HRT group; the abstract provides no event counts or effect estimates.

The findings are observational and based on coded data, so residual confounding and exposure or outcome misclassification remain possible. The results do not establish that HRT is safe for every patient or resolve risks in other surgical populations. The authors call for prospective studies to validate the findings.

In practice

For postmenopausal patients undergoing breast surgery and reconstruction, this propensity-matched database study found no significant association between HRT use in the preceding year and 90-day mortality, venous thromboembolism or wound-healing complications. This is observational evidence, not proof of safety or a basis to alter perioperative HRT decisions: coded exposure and outcomes may be misclassified, residual confounding is possible, and the abstract does not provide event counts or effect estimates. Higher one-year revision rates were reported among HRT users after autologous reconstruction, warranting further study.

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Source

Annals of Surgical Oncology: Postmenopausal Hormone Replacement Therapy is not Associated with Increased Postoperative Complications After Breast Surgery: A Propensity Matched Study ↗

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