The Association Between Obesity, Obstructive Sleep Apnea, and Postoperative Complications in Breast Reduction Patients: A Propensity Score-Matched Analysis

Abstract Background Obstructive sleep apnea (OSA) is associated with increased risk for several comorbidities, with the most prominent being obesity. Obesity is strongly linked to the development of macromastia, a primary indication for breast reduction. It is highly important to assess whether OSA serves as an independent risk factor for postoperative complications. Objectives The aim of this study was to assess the rates of short- and long-term complications following breast reduction in obese patients (BMI >30) with and without documented OSA. Methods A retrospective cohort analysis was conducted using the TriNetX Global Collaborative Network. Patients >18 years, with BMI >30, who underwent breast reduction were divided into 2 groups: those with documented OSA before surgery and those with no history of OSA. Propensity score matching (PSM) was applied to balance demographic and clinical variables. Primary outcomes included short-term postoperative complications at 30, 60, and 90 days. Secondary outcomes included long-term complications after 1 and 2 years. Results After 1:1 PSM, each cohort consisted of 3414 patients. Within 30 days postsurgery, patients in the OSA cohort had a significantly increased risk of surgical-site infection (risk ratio [RR]: 1.444, P = .02), readmission (RR: 1.512, P = .03), inpatient hospitalization (RR: 1.326, P = .04), and opioid use (RR: 1.122, P < .0001) compared with the control group. Results remained consistent at 60 and 90 days postsurgery. For long-term outcomes, OSA patients had reduced rates of breast deformity at 1 year and surgical revision rates at 2 years. Conclusions OSA is associated with increased risk for short-term postoperative complications following breast reduction surgery. However, OSA was paradoxically associated with lower rates of breast deformity and surgical revision. Level of Evidence: 3 (Therapeutic)