Background: Breast reduction is a commonly performed procedure. Understanding the postoperative complication profile is important for preoperative planning and patient education. Objectives: The authors sought to assess complication rates following breast reduction in females and identify potential risk factors. Methods: We assessed the records of the American College of Surgeons National Surgical Quality Improvement Program participant use files that include patients who underwent breast reduction for macromastia between 2005 and 2016. Relevant patient and postoperative data were extracted, and factors affecting complications were analyzed utilizing the logistic regression model. Results: We identified 20,001 women aged a mean 43.9 years who underwent breast reduction. The number of patients who developed ≥1 complication was 1009 (4.3%). Our adjusted analysis revealed that outpatient setting (odds ratio [OR] = 0.600) and performance of the surgery by the attending surgeon alone (OR = 0.678) were associated with lower odds, whereas higher body mass index (OR = 1.046) and smoking (OR = 1.518) were associated with higher odds for complications following breast reduction. Outpatient setting (OR = 0.317) was also associated with lower odds whereas smoking (OR = 1.613) and American Society of Anesthesiologists class were associated with higher odds of returning to the operative room. These findings were consistent in our subgroup analysis for wound-related complications. Conclusions: Our study shows that patient characteristics such as smoking and body mass index may increase complication rates after breast reduction. Clinical factors such as inpatient setting may also increase risk of complications following breast reduction. It is critical to understand the effect of these factors to better predict postoperative outcomes and ensure thorough patient education.

Cast selection for conservatively treated acute scaphoid fractures remains controversial. Cast options include short arm versus long arm, and those that include the thumb or leave it free. We sought to investigate the role of how cast choice affects nonunion rates after conservative management of scaphoid fractures. We searched PubMed, Embase, and Google Scholar from inception through July 14, 2020, according to the Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines. We extracted information of interest, including cast type, and non-union rates at the end of the treatment period. We then performed a meta-analysis using the random-effects model. We identified seven relevant studies. Non-union was observed in 15 out of 156 (9.6%) with short-arm cast and 13 out of the 124 (10.5%) with long-arm cast (OR = 0.79, 95% CI [0.19, 3.26], p = 0.74). Non-union was observed in 18 out of 174 (10.3%) with thumb immobilization cast and 18 out of the 179 (10.1%) without thumb immobilization (OR = 0.97, 95% CI [0.49, 1.94], p = 0.69). In our study, short arm casting was proven non-inferior to long arm casting. Similarly, casts without thumb immobilization were equally as effective as casts with thumb immobilization in terms of non-union rates for acute scaphoid fractures treated non-operatively.