Transfusions in Autologous Breast Reconstructions

Fischer, John P.; Nelson, Jonas A.; Sieber, Brady A.; Stransky, Carrie A.; Kovach, Stephen J.; Serletti, Joseph M.; Wu, Liza C.

doi:10.1097/sap.0b013e318268a803

Cited by 30 publications

(11 citation statements)

References 26 publications

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“…As noted above, most authors have found a correlation between the occurrence of postoperative complications or reconstructive failure and the giving of transfusions during the perioperative period [4,5,[17][18][19][20][21][22]24]. Other variables related to transfusion that have demonstrated an ability to influence the appearance of postoperative complications are the number of transfused concentrates [18] and the period of storage of blood prior to transfusion [23].…”

Section: Discussionmentioning

confidence: 97%

“…The totality of these findings indicates that there is a relationship between transfusion and complications. The majority of authors coincide in pointing out how transfusion during the perioperative period of microsurgery with free flaps increases the risk of medical or surgical complications and increases the duration of the hospital stay and the percentage of failure of the reconstructive procedure [4,5,[17][18][19][20][21][22][23][24].…”

Section: Discussionmentioning

confidence: 99%

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The Effect of Perioperative Blood Transfusions on Microvascular Anastomoses

Gil

Vintró

Fernández

et al. 2021

JCM

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Introduction: Perioperative transfusions are associated with complications of free flaps. The purpose of the present study was to find out whether there is a significant relationship between the risk of developing complications in vascular anastomoses and the history of transfusions. Methods: We studied 372 patients retrospectively with microsurgical reconstruction between 2009 and 2017 with regards to the number of red blood cell concentrates transfused. Complications were analyzed relative to flap loss and complications in microvascular anastomoses. Results: 130 patients (34.9%) received blood transfusions. Some 55% of them were transfused between the day of the intervention and the first postoperative day. Ninety-six patients were reoperated on (25.7%). Of those, thirty-six patients (37.5%) corresponded to anastomosis failure. The percentage of patients transfused among those who required reoperation was 55.2%. The percentage of patients transfused among those who were reoperated on within the first 72 h due to an alteration in the anastomosis was 60.6%, while it was 25.6% (Chi square P = 0.0001) for the rest of the patients. Conclusions: Although there is a strong association between transfusion and vascular anastomosis failure, it is not possible to establish the causation between the two.

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Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

The Effect of Perioperative Blood Transfusions on Microvascular Anastomoses

Gil

Vintró

Fernández

et al. 2021

JCM

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“…The resulting hematoma can compromise flap perfusion by an increased pressure on the microvascular pedicle or directly on the microvascular architecture of the flap. Also, such a bleeding often requires surgical re-exploration and the transfusion of blood products, which is associated with increased morbidity and cost and can further deteriorate the outcome of free tissue transfer [7], [8]. Therefore, the early identification of such patients as well as an early and targeted intervention seems desirable.…”

Section: Discussionmentioning

confidence: 99%

“…On the other hand, postoperative bleeding can lead to hematoma formation, potentially compromising flap perfusion as well as necessitating the transfusion of blood products, which can further worsen outcomes [7], [8], [9]. Most of the available literature regarding the influence of coagulation on microvascular thrombosis and hematoma formation is based on the identification of preoperative markers [2], [10], [11], [12].…”

Section: Introductionmentioning

confidence: 99%

“…There is limited insight into the natural course of these changes over time following major surgery and, to our knowledge, no reports in patients undergoing microvascular reconstruction [18]. Also, the ability to identify patients which are at higher risk to develop postoperative bleeding might lead to reduced transfusion rates, mitigating the associated morbidity and costs [7]. We therefore sought to investigate the short-term changes in coagulation of patients after free flap transfer and their potential influence on microvascular thrombosis and hematoma formation.…”

Section: Introductionmentioning

confidence: 99%

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Insufficient fibrinogen response following free flap surgery is associated with bleeding complications

Kolbenschlag

Diehm²,

Daigeler

et al. 2016

GMS Interdisciplinary Plastic and Reconstructive Surgery DGPW; 5:Doc22

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Association of Anesthesia Duration With Complications After Microvascular Reconstruction of the Head and Neck

Brady

Desai

Crippen

et al. 2018

JAMA Facial Plast Surg

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IMPORTANCE Prolonged anesthesia and operative times have deleterious effects on surgical outcomes in a variety of procedures. However, data regarding the influence of anesthesia duration on microvascular reconstruction of the head and neck are lacking.OBJECTIVE To examine the association of anesthesia duration with complications after microvascular reconstruction of the head and neck. DESIGN, SETTING, AND PARTICIPANTS The American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database was used to collect data. In total, 630 patients who underwent head and neck microvascular reconstruction were recorded in the NSQIP registry from January 1, 2005, through December 31, 2013. Patients who underwent microvascular reconstructive surgery performed by otolaryngologists or plastic surgeons were included in this study. Data analysis was performed from October 15, 2015, to January 15, 2016. EXPOSURES Microvascular reconstructive surgery of the head and neck. MAIN OUTCOMES AND MEASURES Patients were stratified into 5 quintiles based on mean anesthesia duration and analyzed for patient characteristics and operative variables (mean [SD] anesthesia time: group 1, 358.1 [175.6] minutes; group 2, 563.2 [27.3] minutes; group 3, 648.9 [24.0] minutes; group 4, 736.5 [26.3] minutes; and group 5, 922.1 [128.1] minutes). Main outcomes include rates of postoperative medical and surgical complications and mortality. RESULTS A total of 630 patients undergoing head and neck free flap surgery had available data on anesthesia duration and were included (mean [SD] age, 61.6 [13.8] years; 436 [69.3%] male). Bivariate analysis revealed that increasing anesthesia duration was associated with increased 30-day complications overall (55 [43.7%] in group 1 vs 80 [63.5%] in group 5, P = .006), increased 30-day postoperative surgical complications overall (45 [35.7%] in group 1 vs 78 [61.9%] in group 5, P < .001), increased rates of postoperative transfusion (32 [25.4%] in group 1 vs 70 [55.6%] in group 5, P < .001), and increased rates of wound disruption (0 in group 1 vs 10 [7.9%] in group 5, P = .02). No specific medical complications and no overall medical complication rate (24 [19.0%] in group 1 vs 22 [17.5%] in group 5, P = .80) or mortality (1 [0.8%] in group 1 vs 1 [0.8%] in group 5, P = .75) were associated with increased anesthesia duration. On multivariate analysis accounting for demographics and significant preoperative factors including free flap type, overall complications (group 5: odds ratio [OR], 1.98; 95% CI, 1.10-3.58; P = .02), surgical complications (group 5: OR, 2.46; 95% CI, 1.35-4.46; P = .003), and postoperative transfusion (group 5: OR, 2.31; 95% CI, 1.27-4.20; P = .006) remained significantly associated with increased anesthesia duration; the association of wound disruption and increased anasthesia duration was nonsignificant (group 5: OR, 2.0; 95% CI, 0.75-5.31; P = .16). CONCLUSIONS AND RELEVANCEIncreasing anesthesia duration was associated with significantly increased rates of surgical complic...

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Transfusions in Autologous Breast Reconstructions

Abstract: Prognostic/risk category, level III.

Cited by 30 publications

References 26 publications

The Effect of Perioperative Blood Transfusions on Microvascular Anastomoses

The Effect of Perioperative Blood Transfusions on Microvascular Anastomoses

Insufficient fibrinogen response following free flap surgery is associated with bleeding complications

Association of Anesthesia Duration With Complications After Microvascular Reconstruction of the Head and Neck

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