Reducing postoperative venous thromboembolism in DIEP free flap breast reconstruction: Extended pharmacological thromboprophylaxis within an enhanced recovery programme

McKean, Andrew; Knox, Jon; Nanidis, Theodore; Khan, Aadil; Harris, Paul A.; Ramsey, Kelvin; James, Simon; Power, Kieran

doi:10.1016/j.bjps.2021.03.006

Cited by 4 publications

(8 citation statements)

References 3 publications

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“…After manual review of each of these studies by two individuals, 10 studies were identified to be included in this systematic review. 10,21,24–31 A detailed summary of the 10 studies meeting inclusion criteria in the systematic review is presented in Supplemental Digital Content 1. ( See figure, Supplemental Digital Content 1 , http://links.lww.com/PRSGO/C422.)…”

Section: Resultsmentioning

confidence: 99%

“…( See figure, Supplemental Digital Content 3 , which displays the summary of articles in systematic review. 10,21,24–31 http://links.lww.com/PRSGO/C424. )…”

Section: Methodsmentioning

confidence: 99%

“…(See figure, Supplemental Digital Content 3, which displays the summary of articles in systematic review. 10,21,[24][25][26][27][28][29][30][31]…”

Section: Systematic Reviewmentioning

confidence: 99%

“…After manual review of each of these studies by two individuals, 10 studies were identified to be included in this systematic review. 10,21,[24][25][26][27][28][29][30][31] common methodology of these studies was retrospective review (n = 8) with the remaining studies being prospective cohorts (n = 2). One of the retrospective cohort studies also featured a meta-analysis, the data from which were excluded in this systematic review.…”

Section: Systematic Reviewmentioning

confidence: 99%

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Safety and Efficacy of Extended Postdischarge Venous Thromboembolism Prophylaxis in Microsurgical Breast Reconstruction

Hansdorfer

Sadowsky

Horen

et al. 2023

Plastic and Reconstructive Surgery - Global Open

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Background: Discharging patients on extended postoperative venous thromboembolism (VTE) prophylaxis is trending in microsurgical breast reconstruction (MBR). This study investigated contemporary bleeding and thromboembolic complications after MBR and reported postdischarge enoxaparin outcomes. Methods: The PearlDiver database was queried for MBR patients who did not receive postdischarge VTE prophylaxis (cohort 1) and MBR patients discharged with enoxaparin for at least 14 days (cohort 2), then queried for hematoma, deep venous thrombosis (DVT), and/or pulmonary embolism. Concurrently, a systematic review was undertaken to identify studies investigating VTE with postoperative chemoprophylaxis. Results: In total, 13,541 patients in cohort 1 and 786 patients in cohort 2 were identified. The incidence of hematoma, DVT, and pulmonary embolism were 3.51%, 1.01%, 0.55% in cohort 1, and 3.31%, 2.93%, and 1.78% in cohort 2, respectively. There was no significant difference in hematoma between these two cohorts (P = 0.767); however, a significantly lower rate of DVT (P < 0.001) and pulmonary embolism (P < 0.001) occurred in cohort 1. Ten studies met systematic review inclusion. Only three studies reported significantly lower VTE rates with postoperative chemoprophylaxis. Seven studies found no difference in bleeding risk. Conclusions: This is the first study utilizing a national database and a systematic review to investigate extended postoperative enoxaparin in MBR. Overall, rates of DVT/PE seem to be declining compared with previous literature. The results of this study suggest that there remains a lack of evidence supporting extended postoperative chemoprophylaxis, although the therapy appears safe in that it does not increase bleeding risk.

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Section: Resultsmentioning

confidence: 99%

“…( See figure, Supplemental Digital Content 3 , which displays the summary of articles in systematic review. 10,21,24–31 http://links.lww.com/PRSGO/C424. )…”

Section: Methodsmentioning

confidence: 99%

“…(See figure, Supplemental Digital Content 3, which displays the summary of articles in systematic review. 10,21,[24][25][26][27][28][29][30][31]…”

Section: Systematic Reviewmentioning

confidence: 99%

Section: Systematic Reviewmentioning

confidence: 99%

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Safety and Efficacy of Extended Postdischarge Venous Thromboembolism Prophylaxis in Microsurgical Breast Reconstruction

Hansdorfer

Sadowsky

Horen

et al. 2023

Plastic and Reconstructive Surgery - Global Open

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“…Therefore, appropriate perioperative and postoperative coagulopathy prophylaxis is imperative for patients undergoing autologous breast reconstruction. Whereas the American Society of Plastic Surgeons has released guidelines on chemoprophylaxis for the prevention of postoperative venous thromboembolic events, there has been a great deal of research into risk stratifying patients for thromboembolic events and determining optimal prophylactic regimens 25–29 . The Caprini score was created in 1991 and has served as a helpful tool for assessing thromboembolic risk in surgical patients.…”

Section: Discussionmentioning

confidence: 99%

Prior COVID-19 Infection Predisposes to Worse Outcomes After Autologous Breast Reconstruction

et al. 2023

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Background Major shifts in health care systems worldwide have occurred because of coronavirus disease 2019 (COVID-19). With nearly half of all Americans now having a history of COVID-19 infection, there is a pressing need to better understand the importance of prior COVID-19 infection as a potential surgical risk factor. The aim of this study was to investigate the impact of a history of prior COVID-19 infection on patient outcomes after autologous breast reconstruction. Methods We performed a retrospective study using the TriNetX research database, which contains deidentified patient records from 58 participating international health care organizations. All patients who underwent autologous breast reconstruction between March 1, 2020, and April 9, 2022, were included and were grouped based on history of a prior COVID-19 infection. Demographic, preoperative risk factors, and 90-day postoperative complication data were compared. Data were analyzed by propensity score–matched analysis on TriNetX. Statistical analyses were performed by Fisher exact, χ2, and Mann-Whitney U tests as appropriate. Significance was set at P values of <0.05. Results Patients with a history of autologous breast reconstruction within our temporal study window (N = 3215) were divided into groups with (n = 281) and without (n = 3603) a prior COVID-19 diagnosis. Nonmatched patients with prior COVID-19 had increased rates of select 90-day postoperative complications, including wound dehiscence, contour deformities, thrombotic events, any surgical site complications, and any complications overall. Use of anticoagulant, antimicrobial, and opioid medications was also found to be higher in those with prior COVID-19. After performing propensity-score matching, each cohort consisted of 281 patients without statistically significant differences between any baseline characteristics. When comparing outcomes between matched cohorts, patients with a history of COVID-19 had increased rates of wound dehiscence (odds ratio [OR], 1.90; P = 0.030), thrombotic events (OR, 2.83; P = 0.0031), and any complications (OR, 1.52; P = 0.037). Conclusions Our results suggest that prior COVID-19 infection is a significant risk factor for adverse outcomes after autologous breast reconstruction. Patients with a history of COVID-19 have 183% higher odds of postoperative thromboembolic events, warranting careful patient selection and postoperative management.

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A UK consensus statement on thromboprophylaxis for autologous breast reconstruction

Savage

Hunt

Stansby

et al. 2023

Journal of Plastic, Reconstructive & Aesthetic Surgery

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Reducing postoperative venous thromboembolism in DIEP free flap breast reconstruction: Extended pharmacological thromboprophylaxis within an enhanced recovery programme

Cited by 4 publications

References 3 publications

Safety and Efficacy of Extended Postdischarge Venous Thromboembolism Prophylaxis in Microsurgical Breast Reconstruction

Safety and Efficacy of Extended Postdischarge Venous Thromboembolism Prophylaxis in Microsurgical Breast Reconstruction

Prior COVID-19 Infection Predisposes to Worse Outcomes After Autologous Breast Reconstruction

A UK consensus statement on thromboprophylaxis for autologous breast reconstruction

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