Predictors for Prolonged Drain Use Following Autologous Breast Reconstruction

Abstract

Background Surgical drains are routinely used following autologous reconstruction, but are often cited as the leading cause of peri-operative discomfort. This study defined routine drain use duration and assessed the risk factors for prolonged breast and abdominal drain use during microvascular breast reconstruction, measures which have never previously been defined. Methods Patients who underwent an abdominal microvascular free flap were included. Demographics, comorbidities, and operation-related characteristics were retrospectively collected in a prospectively maintained database. Statistical analysis utilized chi-square independent t-test, and linear regression analyses. Results One hundred forty-nine patients comprising 233 breast flaps were included. Average breast and abdominal drain duration were 12.9 ± 3.9 and 17.7 ± 8.2 days, respectively. Prolonged breast and abdominal drain duration were defined as drain use beyond the 75th percentile at 14 and 19 days, respectively. Multivariable regression revealed hypertension was associated with an increased breast drain duration by 1.4 days (p = 0.024), axillary dissection with 1.7 days (p = 0.026), African-American race with 3.1 days (p < 0.001), Hispanic race with 1.6 days (p = 0.029), return to the OR with 3.2 days (p = 0.004), and each point increase in BMI with 0.1 days (p = 0.028). For abdominal drains, each point increase in BMI was associated with an increased abdominal drain duration by 0.3 days (p = 0.011), infection with 14.4 days (p < 0.001), and return to the OR with 5.7 days (p = 0.007). Conclusion Elevated BMI, hypertension, and axillary dissection increase risk for prolonged breast drain requirement in autologous reconstruction. African-American and Hispanic populations experience prolonged breast drain requirement after controlling for other factors, warranting further study.

The Effect of Body Mass Index on Free Flap Breast Reconstruction

“…Dinis et al found BMI to be an independent risk factor for increased drain time. 36 DelMauro and Moon found no correlation between BMI and perforator diameter. 37 Additionally, NSQIP only reflects outcomes for 30 days postoperation, which limits understanding of long-term outcomes relating to obesity.…”

Perceptions of Surgical Drains among Breast Reconstruction Patients and Health Care Staff: A Qualitative Survey Study

“…16 Furthermore, recent findings regarding patient-related factors contributing to prolonged drain duration, such as hypertension and elevated body mass index, may be utilized to establish preoperative goals for patients. 17 While preoperative optimization is valuable in any setting, this may serve as another point of discussion between patients and providers, given the apparently tangible concerns for prolonged indwelling drains and SSI as noted by our study. Of note, recent data suggest the safety and efficacy of drainless donor site closure in autologous breast reconstruction, which may further mitigate concerns for prolonged indwelling drains.…”

A Machine Learning Approach to Predicting Donor Site Complications Following DIEP Flap Harvest

“…Additionally, drains are also a known source of discomfort and dissatisfaction for DIEP flap patients, particularly for those with higher body mass index. 29 Further studies are needed to evaluate how prolonged drainage can be avoided or tailored to improve patient-reported outcomes.…”