Intraoperative perfusion management impacts postoperative outcomes: An analysis of 682 autologous breast reconstruction patients

Nelson, Jonas A.; Fischer, John P.; Grover, Ritwik; Mirzabeigi, Michael N.; Nelson, Priscilla; Wes, Ari M.; Au, Alex; Serletti, Joseph M.; Wu, Liza C.

doi:10.1016/j.bjps.2014.10.002

Cited by 31 publications

(15 citation statements)

References 19 publications

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“…Mean arterial pressure (MAP) was investigated by Nelson et al . and post-hoc analysis couldn’t show any significant difference in patients with and without thrombotic events (p = 0.17) 12 . Our initial analysis of the MAP did not show any significant difference either (data not shown).…”

Section: Discussionmentioning

confidence: 84%

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20 Years of DIEAP Flap Breast Reconstruction: A Big Data Analysis

Depypere

Herregods

Denolf³

et al. 2019

Sci Rep

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With every hospital admission, a vast amount of data is collected from every patient. Big data can help in data mining and processing of this volume of data. The goal of this study is to investigate the potential of big data analyses by analyzing clinically relevant data from the immediate postoperative phase using big data mining techniques. A second aim is to understand the importance of different postoperative parameters. We analyzed all data generated during the admission of 739 women undergoing a free DIEAP flap breast reconstruction. The patients’ complete midcare nursing report, laboratory data, operative reports and drug schedule were examined (7,405,359 data points). The duration of anesthesia does not predict the need for revision. Low Red Blood cell Counts (3.53 × 106/µL versus 3.79 × 106/µL, p < 0.001) and a low MAP (MAP = 73.37 versus 76.62; p < 0.001) postoperatively are correlated with significantly more revisions. Different drugs (asthma/COPD medication, Butyrophenones) can also play a significant role in the success of the free flap. In a world that is becoming more data driven, there is a clear need for electronic medical records which are easy to use for the practitioner, nursing staff, and the researcher. Very large datasets can be used, and big data analysis allows a relatively easy and fast interpretation all this information.

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Section: Discussionmentioning

confidence: 84%

“…Blood loss is also well documented 10,12 . As every lab result has a time label, we could generate the data of individual patients and compare their pre- and postoperative values.…”

Section: Discussionmentioning

confidence: 98%

20 Years of DIEAP Flap Breast Reconstruction: A Big Data Analysis

Depypere

Herregods

Denolf³

et al. 2019

Sci Rep

View full text Add to dashboard Cite

show abstract

“…Nelson et al reported that less than 7 mL/kg/h of intraoperative fluids increased the risk of postoperative thrombosis above their average rate of 4%. 24 Our rate of thrombosis was lower in OFA and OA (1.8% vs. 3.4%). Dexmedetomidine causes direct vasoconstriction, 25 but its indirect sympatholytic effects are more pronounced, which results in vasodilation.…”

Section: Discussionmentioning

confidence: 50%

Impact of opioid-free anesthesia on complications after deep inferior epigastric perforator flap surgery: A retrospective cohort study

Mulier¹,

Frene²,

Benmeridja³

et al. 2021

Journal of Plastic, Reconstructive & Aesthetic Surgery

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This study measured the number of complications after deep inferior epigastric perforator (DIEP) flap reconstruction performed under opioid-free anesthesia (OFA) combined with goal-directed fluid therapy or opioid anesthesia with liberal fluid therapy (OA). This retrospective cohort study consisted of 204 patients who underwent DIEP flap reconstruction at AZSint Jan Brugge between April 2014 and March 2019. Primary outcomes were complications, according to the Clavien-Dindo classification and the length of hospital stay (LOS). The secondary outcomes were flap failure, postoperative nausea and vomiting (PONV), postoperative pain, postoperative opioid consumption, and postoperative skin flap temperature. OFA included

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“…Data from two retrospective studies demonstrate that excessive underresuscitation contributes to an increased risk for adverse flap events. 114 , 115 Similarly, retrospective studies have shown liberal fluid resuscitation or fluid overload increases flap complications in both breast reconstruction and other microvascular flap procedures. 115 – 119 In the nonfree flap population, meta-analyses of RCTs reaffirm the value of balanced fluid therapy in reducing perioperative complications and LOS.…”

Section: Evidence-based Recommendations For Components Of Eras Protocmentioning

confidence: 99%

Paravertebral blocks and enhanced recovery after surgery protocols in breast reconstructive surgery: patient selection and perspectives

Parikh¹,

Myckatyn²

2018

JPR

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The management of postoperative pain is of critical importance for women undergoing breast reconstruction after surgical treatment for breast cancer. Mitigating postoperative pain can improve health-related quality of life, reduce health care resource utilization and costs, and minimize perioperative opiate use. Multimodal analgesia pain management strategies with nonopioid analgesics have improved the value of surgical care in patients undergoing various operations but have only recently been reported in reconstructive breast surgery. Regional anesthesia techniques, with paravertebral blocks (PVBs) and transversus abdominis plane (TAP) blocks, and enhanced recovery after surgery (ERAS) pathways have been increasingly utilized in opioid-sparing multimodal analgesia protocols for women undergoing breast reconstruction. The objectives of this review are to 1) comprehensively review regional anesthesia techniques in breast reconstruction, 2) outline important components of ERAS protocols in breast reconstruction, and 3) provide evidence-based recommendations regarding each intervention included in these protocols. The authors searched across six databases to identify relevant articles. For each perioperative intervention included in the ERAS protocols, the literature was exhaustively reviewed and evidence-based recommendations were generated using the Grading of Recommendations, Assessment, Development, and Evaluation system methodology. This study provides a comprehensive evidence-based review of interventions to optimize perioperative care and postoperative pain control in breast reconstruction. Incorporating evidence-based interventions into future ERAS protocols is essential to ensure high value care in breast reconstruction.

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Intraoperative perfusion management impacts postoperative outcomes: An analysis of 682 autologous breast reconstruction patients

Cited by 31 publications

References 19 publications

20 Years of DIEAP Flap Breast Reconstruction: A Big Data Analysis

20 Years of DIEAP Flap Breast Reconstruction: A Big Data Analysis

Impact of opioid-free anesthesia on complications after deep inferior epigastric perforator flap surgery: A retrospective cohort study

Paravertebral blocks and enhanced recovery after surgery protocols in breast reconstructive surgery: patient selection and perspectives

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