Operative Time and Flap Failure in Unilateral and Bilateral Free Flap Breast Reconstruction

Kwok, Alvin C.; Edwards, Kyle; Donato, Daniel P.; Tatro, Eric; Xu, Yizhe; Presson, Angela P.; Agarwal, Jayant P.

doi:10.1055/s-0038-1627445

Cited by 21 publications

(21 citation statements)

References 22 publications

(16 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Our results showed that odds of UR, eLOS, donor-site complications, medical complications, flap-site complications, fat necrosis, blood transfusion, flap compromise, and flap loss significantly increase per hour of OT in DIEP flap reconstructions, supporting the findings of previous free flap literature. 2,22,24,25,28–30 Although eLOS is significantly associated with both per hour and OT intervals, our results suggest that postoperative morbidity and UR with DIEP flap reconstructions increases per hour of OT rather than OT intervals after adjusting for intraoperative, perforator, and demographic variables. Overall, it appears OT per hour is a more universal predictor of adverse postoperative outcomes (ie, eLOS, UR, and complication occurrence) compared to OT cutoffs and intervals.…”

Section: Discussionmentioning

confidence: 63%

Operative Time Predicts Postoperative Outcomes in Bilateral DIEP Flap Reconstruction: Multivariate 1000 Flap Analysis

Haddock

Wen

Steppe

et al. 2022

Plastic and Reconstructive Surgery - Global Open

View full text Add to dashboard Cite

Background: Skin-to-skin operative time (OT) as a risk factor for adverse postoperative outcomes in microvascular breast reconstruction has not been thoroughly investigated. This study evaluates OT’s impact on length of stay (LOS), overall morbidity, individual complications, and unplanned reoperation (UR) in deep inferior epigastric artery perforator (DIEP) flaps, with a primary objective of identifying a clinically relevant time of decreased odds. Methods: Patients who underwent bilateral DIEP flaps from 2010 to 2021 by two senior surgeons (N.T.H. and S.S.T.) with standardized surgical and postoperative protocols were retrospectively reviewed. One thousand flaps (500 patients) were analyzed with extensive multivariate regression equations to adjust for potential confounders, including intraoperative complexity. The odds of postoperative complication, extended LOS (eLOS, defined as ≥5 days) were compared across OT per hour and OT intervals. Results: After risk-adjustment, each hour of OT increased morbidity by 19%, UR by 8.7%, and LOS by 6.5 hours (all P < 0.001). For eLOS, procedures ≤5 hours had 9.5 times lower odds than ≥5 hours (P = 0.050), 5–7 hours had comparable odds (P = 0.540), and 7–9 hours had 5.5 times lower odds than procedures ≥ 9 hours (P < 0.001). Last, a multivariate linear regression showed that LOS can be calculated from OT: LOS (days) =1.527 + 0.272 × OT (hours) (R2 = 0.308; P < 0.001). Conclusions: OT (per hour) independently predicts morbidity, UR and LOS in DIEP flaps. Furthermore, 5 and 9 hours are critical cutoffs for eLOS. These findings emphasize the benefits of decreasing OT through efficiency models, such as process analysis, team-based intraoperative protocols, and co-surgery model.

show abstract

Section: Discussionmentioning

confidence: 63%

Operative Time Predicts Postoperative Outcomes in Bilateral DIEP Flap Reconstruction: Multivariate 1000 Flap Analysis

Haddock

Wen

Steppe

et al. 2022

Plastic and Reconstructive Surgery - Global Open

View full text Add to dashboard Cite

show abstract

“…Covariates for this model included age, race, body mass index (BMI), diabetes, hypertension, ASA classification, and laterality of reconstruction. 15 All analyses were performed using R 4.2.1 (R Foundation, Vienna, Austria) and the p-value for statistical significance was set at p < 0.05.…”

Section: Discussionmentioning

confidence: 99%

“…Covariates for this model included age, race, body mass index (BMI), diabetes, hypertension, ASA classification, and laterality of reconstruction. 15 All analyses were performed using R 4.2.1 (R reconstructive options. Our data suggests that DIBR and DBR are associated with less overall complications than IBR.…”

Section: Discussionmentioning

confidence: 99%

A Comparison of Postoperative Outcomes Between Immediate, Delayed Immediate, and Delayed Autologous Free Flap Breast Reconstruction: Analysis of 2010–2020 NSQIP Data

Marquez

Sudduth

Kuo

et al. 2023

J Reconstr Microsurg

View full text Add to dashboard Cite

Introduction While many factors influence decisions related to the timing between mastectomy and flap-based breast reconstruction, there is limited literature comparing postoperative complications between immediate (IBR), delayed immediate (DIBR), and delayed (DBR) reconstruction modalities. Using the National Surgical Quality Improvement Program (NSQIP), we sought to compare postoperative complication rates of each timing modality. Methods The NSQIP 2010-2020 database was queried for patients who underwent free flap breast reconstruction. Cases were categorized to include mastectomy performed concurrently with a free flap reconstruction, removal of a tissue expander with free flap reconstruction, and free flap reconstruction alone which are defined as IBR, DIBR, and DBR, respectively. The frequency of postoperative outcomes including surgical site infection (SSI), wound dehiscence, intraoperative transfusion, deep venous thrombosis (DVT), and return to operating room (OR) were assessed. Overall complication rates, hospital length of stay (LOS), and operative time were analyzed. Multivariable regression analysis controlling for age, race, BMI, diabetes, hypertension, ASA class, and laterality was performed. Results A total of 7907 cases that underwent IBR, DIBR (n=976), and DBR reconstruction (n=6713) were identified. No statistical difference in occurrence of SSI’s, wound dehiscence, or DVT were identified. DIBR (9%) and DBR (11.9%) were associated with less occurrences of reoperation than IBR (13.2%, p<0.001). Univariate and multivariate regression analysis demonstrated that DIBR and DBR were associated with a lower odds of complications and shorter operation time versus IBR. No statistically significant differences between DIBR and DBR in surgical complications, LOS, and operative time were identified. Conclusion Awareness of overall complication rates associated with each reconstructive timing modality can be used to help guide physicians when discussing reconstructive options. Our data suggests that DIBR and DBR are associated with less overall complications than IBR. Physicians should continue to consider patients’ unique circumstances when deciding upon which timing modality is appropriate.

show abstract

“…Another study on free flap breast reconstruction showed that DM was not a significant predictor of flap failure. [30] Despite the conflicting results found in various studies, DM remains a concern for surgeons. This is because it is associated with other surgical and medical complications such as bleeding, postoperative ventilation > 48 hours, and pneumonia.…”

Section: Diabetes Mellitusmentioning

confidence: 99%

“…Another result of breast reconstruction with bilateral free flaps did not find a significant relationship with failure compared to unilateral free flaps even though the operating time was longer. [42] Surgical time has not been reported to be associated with an increase in overall complications (early or late) in free flap breast reconstruction. [43] Gürlek et al wrote that flap loss was not found to be significantly different between groups with ischemic time less than and more than 3 hours in head neck and breast reconstruction in Texas.…”

Section: Operation Durationmentioning

confidence: 99%

A Meta-Analysis Study: Risk Factors of Total Flap Necrosis in Microsurgery

Sastri¹,

Rizaliyana²,

Nata'atmadja³

2023

IJRP

View full text Add to dashboard Cite

Background:Free flap surgery allows closure of the defect with excellent results. Developed knowledge and skills lead to higher success rates. Failure to do so in the form of total flap necrosis can cause burdensome problems for both the surgeon and the patient. We performed a meta-analysis to analyze several risk factors for total flap necrosis in free flap surgery. Age, gender, diabetes mellitus (DM), hypertension (HT), duration of surgery, blood transfusions, and intraoperative intravenous fluids are among them. Methods:This study was prepared using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flowchart. We used the PubMed, Science Direct, Proquest, and Web of Science databases from January 2019 to December 2020. The selected articles described free flaps and included the number of cases according to variables and the incidence of total flap necrosis. Results:We found thirteen articles met the criteria for meta-analysis. A total of 2,063 free flaps were documented, and 65.9% were male patients. Most of the defects were caused by malignancies (75.4%). The most common location was the head and neck (72.7%). Free flaps from the lateral circumflex femoral system and the radial forearm are the two most common types of free flaps. The overall success of the free flap in this study was 93.45%, while the failure rate was 6.55%. Total necrosis was found in 23% of all postoperative complications. There were no significant differences in criteria for old age (> 60 years), female gender, DM, HT, and duration of surgery. Transfusions or intraoperative fluid administration cannot be concluded from this research. Conclusion:The causes of free flap failure are multifactorial and no absolute contraindications to surgery are mentioned in the literature. Some of the factors analyzed in this study were not significant as the risk of total free flap necrosis but could lead to other surgical or medical complications. However, further studies are needed.

show abstract

Operative Time and Flap Failure in Unilateral and Bilateral Free Flap Breast Reconstruction

Abstract: Bilateral free flap breast reconstruction can be performed safely despite an increase in operative time when compared with unilateral reconstruction.

Cited by 21 publications

References 22 publications

Operative Time Predicts Postoperative Outcomes in Bilateral DIEP Flap Reconstruction: Multivariate 1000 Flap Analysis

Operative Time Predicts Postoperative Outcomes in Bilateral DIEP Flap Reconstruction: Multivariate 1000 Flap Analysis

A Comparison of Postoperative Outcomes Between Immediate, Delayed Immediate, and Delayed Autologous Free Flap Breast Reconstruction: Analysis of 2010–2020 NSQIP Data

A Meta-Analysis Study: Risk Factors of Total Flap Necrosis in Microsurgery

Contact Info

Product

Resources

About