Audit of venous thromboembolism in DIEP free flap breast reconstruction

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

doi:10.1016/j.bjps.2017.02.023

Cited by 6 publications

(4 citation statements)

References 4 publications

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“…28 The duration of chemoprophylaxis has been shown to vary where McKean et al recommend patients receive extended LMWH postdischarge, completing a total of 14 days of treatment. 29 In our study, 40 mg of enoxaparin is initiated on a postoperative day 1 until discharge. Additionally, patients are placed on 81 mg of aspirin daily for 30 days postoperatively.…”

Section: Discussionmentioning

confidence: 99%

An Effective Protocol for Perioperative Venous Thromboembolism Prophylaxis in DIEP Flap Breast Reconstruction: A Single Institution Retrospective Review

Moreno,

Essex,

Collins

2024

Plastic and Reconstructive Surgery - Global Open

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Background: Deep inferior epigastric artery perforator (DIEP) free flap breast reconstruction is one of the most highly used procedures for autologous breast reconstruction. Many venous thromboembolism (VTE) risk assessment models have been proposed in breast reconstructive surgery, including the widely used Caprini score. However, a paucity of data suggests an effective standardized VTE protocol. The purpose of this study was to determine the rate of VTE in our DIEP flap patients who were treated with this protocol. Methods: A retrospective single-center review of DIEP flap breast reconstruction from 2016 to 2021 was performed. Data were collected on 554 patients and 893 flaps including demographics, intraoperative and perioperative details, and postoperative course. Patients who were not treated with our standard protocol were excluded. Data were analyzed with alpha = 0.05. Results: The average age was 50.4 ± 9.9 years, and the total follow-up time was 16.9 ± 12.6 months. The average body mass index for the cohort was 30.1 ± 5.2. During the 90 postoperative days, the mean length of hospital stay was 4.3 days. There were six cases of postoperative VTE: five patients presented with pulmonary embolism (0.9%) and one patient (0.2%) had deep venous thrombosis with an overall VTE prevalence of 1.1%. No specific single factor could be attributed to VTE occurrence. Conclusions: Using our standardized VTE prophylaxis protocol, our institution was effective at keeping VTE rates low. Additional studies would be beneficial to determine optimal VTE prophylaxis protocols in higher-risk patients, such as those with known clotting disorders.

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Section: Discussionmentioning

confidence: 99%

An Effective Protocol for Perioperative Venous Thromboembolism Prophylaxis in DIEP Flap Breast Reconstruction: A Single Institution Retrospective Review

Moreno,

Essex,

Collins

2024

Plastic and Reconstructive Surgery - Global Open

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“…Characteristics of the patients who developed VTE are summarized in Table 3. Of the 11 patients who developed VTE, median Caprini score was 7 (range, [4][5][6][7][8][9][10][11][12]. Two (18%) patients had a prior history of VTE, and 2 (18%) patients had a family history of VTE.…”

Section: Venous Thromboembolismmentioning

confidence: 99%

“…Second, the harvest of the abdominal DIEP flap may increase intraabdominal pressure upon closure and reduce venous return. [9][10][11][12] Many patients undergoing DIEP flap procedures have prior or concomitant breast cancer, which can induce a systemic hypercoagulable state and hormonal breast cancer therapies such as tamoxifen may further increase the risk of VTE. 13,14 Overall, as VTE events are associated with serious complications including increased mortality, bleeding risk, and increased health care costs due to prolonged hospitalization and readmission; [15][16][17] there is a critical need to accurately characterize VTE incidence and risk-stratify patients undergoing DIEP procedures.…”

mentioning

confidence: 99%

Incidence of Venous Thromboembolism Based on Caprini Score in Deep Inferior Epigastric Perforator Flap Breast Reconstruction

Raymer

Schafer

et al. 2023

J Reconstr Microsurg

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Background Deep inferior epigastric perforator (DIEP) flaps are commonly used for autologous breast reconstruction, but reported rates of venous thromboembolism (VTE) are up to 6.8%. This study aimed to determine incidence of VTE based on preoperative Caprini score following DIEP breast reconstruction. Methods This retrospective study included patients who underwent DIEP flaps for breast reconstruction between January 1, 2016 and December 31, 2020 at a tertiary-level, academic institution. Demographics, operative characteristics, and VTE events were recorded. Receiver operating characteristic (ROC) analysis was performed to determine area under curve (AUC) of Caprini score for VTE. Univariate and multivariate analyses assessed risk factors associated with VTE. Results This study included 524 patients (mean age 51.2±9.6 years). There were 123 (23.5%) patients with Caprini score of 0-4, 366 (69.8%) with scores 5-6, 27 (5.2%) with scores 7-8, and 8 (1.5%) patients with scores >8. Postoperative VTE occurred in 11 (2.1%) patients, at a median time of 9 days (range 1-30) after surgery. VTE incidence by Caprini score was 1.9% for scores 3-4, 0.8% for scores 5-6, 3.3% for scores 7-8, and 13% for scores >8. Caprini score achieved an AUC of 0.70. A Caprini score >8 was significantly predictive of VTE on multivariable analysis relative to scores 5-6 (OR 43.41, 95% CI 7.46-252.76, p<0.001). Conclusions In patients undergoing DIEP breast reconstruction, VTE incidence was highest (13%) in Caprini scores greater than 8 despite chemoprophylaxis. Future studies are needed to assess the role of extended chemoprophylaxis in patients with high Caprini scores.

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“…55,56 Risk factors for DVT include prolonged surgery, positive BRCA status, greater age, high BMI, concurrent tamoxifen therapy, and delayed mobilization. 56,57 Practices in DVT prophylaxis vary greatly among reconstructive breast surgeons, and most report noncompliance with American College of Chest Physicians (ACCP) guidelines. 58 Lowmolecular weight heparin (LMWH) is often the prophylactic medication of choice and given daily to all patients throughout the course of admission.…”

Section: Complicationsmentioning

confidence: 99%

Free Tissue Breast Reconstruction

Dibbs

Trost

DeGregorio

et al. 2019

Seminars in Plastic Surgery

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Free tissue transfer serves as a modern workhorse for breast reconstruction. Advancements in microsurgical technique have allowed for the development of free flap procedures that produce an aesthetic breast while minimizing donor site morbidity. Here, the authors review the use of different free flap procedures for breast reconstruction with a focus on the preferred and most commonly used flap, the deep inferior epigastric perforator flap. Each flap has its advantages and drawbacks, and certain patient risk factors increase postoperative complications. Other techniques of breast reconstruction including pedicled flaps and adjunctive fat grafting are also briefly discussed.

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Audit of venous thromboembolism in DIEP free flap breast reconstruction

Cited by 6 publications

References 4 publications

An Effective Protocol for Perioperative Venous Thromboembolism Prophylaxis in DIEP Flap Breast Reconstruction: A Single Institution Retrospective Review

An Effective Protocol for Perioperative Venous Thromboembolism Prophylaxis in DIEP Flap Breast Reconstruction: A Single Institution Retrospective Review

Incidence of Venous Thromboembolism Based on Caprini Score in Deep Inferior Epigastric Perforator Flap Breast Reconstruction

Free Tissue Breast Reconstruction

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