Use of Thromboprophylaxis after Autologous Breast Reconstruction: A Cost-Effective Break-Even Analysis

Abstract

Purpose: Post-operative venous thromboembolism (VTE) is a major source of morbidity and mortality. The use of thromboprophylaxis amongst surgeons is not well studied in autologous breast reconstruction. The purpose of this study was to determine the rate of VTE in breast cancer patients undergoing autologous breast reconstruction and to compare the cost-effectiveness of postoperative chemoprophylactic agents. Methods: The TriNetX LLC. National Health Research Network database was used to identify patients with breast cancer who underwent autologous breast reconstruction surgery between 2002-2022. The incidence of occurrence of VTE within the first 30 days of surgery was calculated. Then a break-even analysis was performed to determine the break-even rate of VTE at which the chemoprophylactic agent would be cost effective. Results: A cohort of 8,221 patients was identified in this study. The rate of VTE was significantly higher in those without anticoagulation (4.0%) compared to those who received anticoagulation (2.6%) (*p=0.0008). The break-even analysis for heparin and enoxaparin’s cost-effectiveness yielded ARRs of 0.73% and 1.63% for high risk patients requiring 30 days of therapy and 0.20% and 0.43% for moderate risk patients requiring 7 days of therapy, respectively. Conclusion: The use of thromboprophylaxis significantly lowered the risk of VTE within 30 days after autologous breast reconstruction. Heparin appeared to be more cost-effective at preventing VTE compared to enoxaparin for both high and moderate risk patients. The presented model holds potential for other institution-specific variables that can be easily applied by plastic surgeons to determine the cost-effectiveness of any therapy of their choice.

The radiated breast and autologous reconstruction: benefits and alternatives

“…The triple anti-thrombotic regimen referenced in the study consisted of preoperative low molecular weight heparin (LMWH), intraoperative heparin, and dextran. However, cessation of the regimen was associated with fewer hematomas and did not increase flap thromboembolic events [51] . Postoperative immobility is often a concern in flap patients.…”

“…The radiation-induced chronic inflammation renders vessels hypercoagulable [8] , which raises concerns for flap failure. Jakobsson et al found that hematoma was the most common reason for re-exploration after free flap, and that the use of a triple anti-thrombotic regimen was significantly associated with hematoma formation [51] . The triple anti-thrombotic regimen referenced in the study consisted of preoperative low molecular weight heparin (LMWH), intraoperative heparin, and dextran.…”