Surgical Duration Impacts Venous Thromboembolism Risk in Microsurgical Breast Reconstruction

Qiu, Cecil S.; Jordan, Sumanas W.; Dorfman, Robert; Vu, Michael M.; Alghoul, Mohammed S.; Kim, John Y.S.

doi:10.1055/s-0037-1606339

Cited by 23 publications

(18 citation statements)

References 56 publications

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“…Similarly, operative time has been shown in various papers to be associated with adverse outcomes in free flap breast reconstruction. 30,31 In a landmark paper by Kwok et al, the NSQIP database was queried for patients undergoing free flap breast reconstruction. The authors concluded that prolonged operative time is associated with an increased probability of flap failure.…”

Section: Discussionmentioning

confidence: 99%

Impact of Blood Transfusion in Free Flap Breast Reconstruction Using Propensity Score Matching

Karamanos

Shah

Kim

et al. 2020

J Reconstr Microsurg

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Background Microvascular thrombosis has been associated with cytokine release and inflammatory syndromes which can occur as a result of blood transfusions. This phenomenon could potentially lead to complications in breast free flap reconstruction. The aim of this study was to evaluate the impact of perioperative blood transfusion in free flap breast reconstruction using large population analysis. Methods The American College of Surgeons National Quality Improvement Program database was queried for delayed free flap breast reconstructions performed in 2016. The study population was divided based on perioperative blood transfusion within 24 hours of the start of the operation. Propensity score matching analysis was used to ensure homogeneity between the two study groups. Primary outcome was unplanned return to the operating room (OR) within 30 days. Secondary outcomes were readmission and complications. Results A total of 1,256 patients were identified. Out of those, 91 patients received a perioperative blood transfusion. All the patients received only one unit of PRBC within the first 24 hours. Those patients were matched with similar patients who did not receive a transfusion on a ratio of 1:3 (273 patients). Patients who received a transfusion had a significantly higher incidence of reoperation (42 vs. 10%, p < 0.001). Patients who received a transfusion were more likely to return to the OR after 48 hours from the initial operation (13 vs. 5%, p = 0.001). All returns to the OR were due to flap-related complications. Perioperative blood transfusion increased the incidence of wound dehiscence (9 vs. 2%, p = 0.041) but had no protective effect on the development of other postoperative complications. Conclusion Perioperative blood transfusion in free flap breast reconstruction is associated with an increased probability of flap-related complications and subsequent return to the OR without decreasing the probability of developing other systemic postoperative complications.

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Section: Discussionmentioning

confidence: 99%

Impact of Blood Transfusion in Free Flap Breast Reconstruction Using Propensity Score Matching

Karamanos

Shah

Kim

et al. 2020

J Reconstr Microsurg

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“…Prolonged operative time has more frequently been mentioned as an important factor for complications, especially in free flap breast reconstruction. [19][20][21] To further specify our analysis, overall complication rate was analyzed using the same logistic regression model on separate datasets for each type of procedure. In our logistic regression model, cases with missing data were excluded of analysis by case-wise deletion.…”

Section: Discussionmentioning

confidence: 99%

Racial Disparities in Outcomes of Reconstructive Breast Surgery: An Analysis of 51,362 Patients from the ACS-NSQIP

Blankensteijn

Sparenberg

Crystal

et al. 2020

J Reconstr Microsurg

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Background In various surgical specialties, racial disparities in postoperative complications are widely reported. It is assumed that the effect of race can also be found in plastic surgical outcomes, although this remains largely undefined in literature. This study aims to provide data on the impact of race on outcomes of reconstructive breast surgery. Methods Data were collected using the NSQIP (National Surgical Quality Improvement Program) database (2008–2016). Outcomes of the reconstructive breast surgery of White patients were compared with those of African American, Asian, or other races. Logistic regression was performed to control for variations between all groups. Analysis of racial disparities was further sub-stratified according to four different types of breast reconstruction: delayed or immediate autologous, and delayed or immediate prosthesis-based reconstruction. Results In total, this study included 51,362 patients of which 43,864 were Caucasian, 5,135 African American, 2,057 Asian, and 332 of other races. When compared with White patients, patients of African American race had larger body mass indices (31.3 ± 7.0 vs. 27.6 ± 6.3, p-value < 0.001) in addition to higher rates of diabetes (12.3 vs 4.6%, p-value < 0.001) and hypertension (44.7 vs. 23.4%, p-value < 0.001). Both multivariate analysis and the sub-stratified analysis of different types of reconstruction showed no differences in overall complication rate. Conclusion Among the four types of reconstructive procedures, differences in surgical outcomes do not appear to be based on race and therefore seem to be less evident in reconstructive breast surgery compared with the current literature within other surgical specialties.

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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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Surgical Duration Impacts Venous Thromboembolism Risk in Microsurgical Breast Reconstruction

Abstract: Risk, II.

Cited by 23 publications

References 56 publications

Impact of Blood Transfusion in Free Flap Breast Reconstruction Using Propensity Score Matching

Impact of Blood Transfusion in Free Flap Breast Reconstruction Using Propensity Score Matching

Racial Disparities in Outcomes of Reconstructive Breast Surgery: An Analysis of 51,362 Patients from the ACS-NSQIP

Free Tissue Breast Reconstruction

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