Anemia is not a predictor of free flap failure: A review of NSQIP data

Abstract

Background Thrombosis is a common cause of flap failure in microvascular tissue transfer, which questions the effects of anemia on this outcome. This article seeks to contribute a large, multi‐institutional data analysis to this debate. Methods Free tissue transfer patients were identified in the National Surgical Quality Improvement database through a specified Current Procedural Terminology algorithm. Bivariate analysis compared anemic and nonanemic groups with respect to flap failure and other outcomes. Multivariable logistic regression was used to determine risk factors for flap failure. Results Of the 864 patients who met inclusion criteria, 244 were anemic and 620 were not. Bivariate analysis showed no significant difference between groups with respect to flap failure (3.28% vs. 4.03%, P = 0.0603). Multivariate regression analysis supported this (OR 95% CI = 0.371–1.912). Conclusions These findings, based on the largest sample in the literature, show anemia is neither a predictor of free tissue transfer failure nor is it protective. © 2013 Wiley Periodicals, Inc. Microsurgery 33:432–438, 2013.

Intraoperative Transfusion of Packed Red Blood Cells in Microvascular Free Tissue Transfer Patients: Assessment of 30-Day Morbidity Using the NSQIP Dataset

“…Our own data reviewing preoperative hematocrit and free flap failure showed no relationship between flap failure and anemia, but did demonstrate increased reoperation rates and surgical complications in the anemic cohort (p ¼ 0.022 and p ¼ 0.082, respectively). 24 In contrast, a study by Namdar et al found a significant association between saline infusion volumes and flap loss, as well as total infusion volume to body weight ratios and flap loss. 46 Again, they were limited by a sample size of 48, with only four flap losses.…”

“…23 A recent study of 864 free flap patients did not find any relationship between preoperative hemoglobin level and flap-related complications. 24 Keywords ► transfusion ► free flap ► microsurgery ► NSQIP…”

Predictive risk factors of free flap thrombosis in breast reconstruction surgery

“…However, our study showed that hypertension (AOR, 0.36) and debates mellitus (AOR, 0.35) were associated with a lower rate of flap thrombosis with unknown etiology. Although, we did not evaluate the effect of anemia on flap thrombosis, Mlodinow et al showed that anemia is neither a predictor of free tissue transfer failure nor is it protective. Age, too, was a patient variable that did not affect the rate of thrombotic complications.…”

Effect of perioperative transfusion of old red blood cells on postoperative complications after free muscle sparing transverse rectus abdominis myocutaneous flap surgery for breast reconstruction

“…A literature review showed inconsistent results concerning the effect of preoperative anemia on postoperative flap failure. A recent study using the National Surgical Quality Improvement Program demonstrated that preoperative anemia did not predict flap failure after free flap reconstructive surgery . By contrast, another recent report showed that preoperative anemia was directly related to vascular thrombosis and free flap failure in microvascular reconstruction, and especially, patients with preoperative hematocrit level less than 30% had more chance of flap failure .…”