Bleeding After Free Flap-Based Breast Reconstruction: A NSQIP Analysis

Abstract

Background Despite limited oncologic benefit for women without an increased risk for breast cancer, the rates of contralateral prophylactic mastectomy (CPM) have increased. Patients undergoing CPM are more likely to undergo bilateral and immediate breast reconstruction. This study assessed the relationship between the timing and laterality of free flap-based breast reconstruction and the risk of postoperative bleeding complications. Methods Women undergoing postmastectomy free-flap based breast reconstruction from 2010 to 2015 were identified using the National Surgical Quality Improvement Program (NSQIP) dataset. Patients were categorized according to reconstructive laterality and timing. Modified Poisson regression was used to assess the risk of postoperative bleeding and complications across reconstructive procedures. Results Of the 4,133 patients undergoing free flap-based breast reconstruction, 12% (n = 494) experienced postoperative bleeding complications. Bilateral immediate reconstruction was associated with the highest incidence of bleeding (16.6%, n = 188), followed by bilateral delayed (12.8%, n = 58), unilateral immediate (10%, n = 142), and unilateral delayed reconstruction (9.4%, n = 106). Among patients undergoing immediate reconstruction, bilateral, rather than unilateral, reconstruction was associated with a significantly elevated risk of bleeding complications (RR [rate ratio] = 1.58; 95% CI [confidence interval] =1.19, 2.10; p = 0.0002). Furthermore, immediate bilateral reconstruction was associated with a significantly higher rate of return to the operating room (RR =1.39; 95% CI =1.06, 1.82; adjusted p = 0.009) when compared with a unilateral procedure. Conclusion Patients undergoing immediate bilateral free flap-based breast reconstruction may be at an increased risk for experiencing acute postoperative bleeding complications and a return to the operating room. Patients undergoing CPM and considering immediate reconstruction should be counseled regarding the increased morbidity of a bilateral reconstructive procedure.

A Comparison of Surgical Complications in Patients Undergoing Delayed versus Staged Tissue-Expander and Free-Flap Breast Reconstruction

“…23,24 Considered together, our findings echo prior studies that show immediate breast reconstruction is associated with higher rates of postoperative complications, and that two-stage breast reconstruction is associated with an increased frequency of postoperative complications in the first reconstructive stage. 1,[10][11][12]20,[25][26][27] The relatively high complication rates observed in the staged cohort may in part be attributable to the study's inclusion criteria. However, the goal of this study was to provide clinicians and patients with an accurate sense of how staged free-flap breast reconstruction may influence the reconstructive course for patients who may otherwise undergo a delayed approach.…”

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

“…This is particularly important as patients undergoing immediate bilateral flap-based reconstruction are more prone to complications. 30,31 Second, Magno-Padron et al recently described the classic 30-day complication variable as potentially missing a significant number of late readmissions and complications using the Nationwide Readmission Database. 32 This can also contribute to underestimation of the complication rate identified in our study.…”

Incidência e fatores associados a complicações em feridas operatórias de mulheres mastectomizadas

“…O sangramento é uma complicação hemorrágica que, em muitos casos, resulta em reabordagem cirúrgica, prolongando o tempo de internação em 1,3 dias e aumentando os custos hospitalares em $ 5.495 dólares por admissão 23 . Nos limites da comparação, os resultados do presente estudo evidenciam que a incidência de sangramento em cirurgia mamária é superior à observada em estudos realizados nos Estados Unidos 2,54% 23 e 12% 24 . Dentre os principais fatores de risco, destacam-se: obesidade, insuficiência cardíaca congestiva e doença pulmonar crônica 23 .…”