Venous Thromboembolism following Microsurgical Breast Reconstruction: A Longitudinal Analysis of 12,778 Patients

Abstract

Background: Venous thromboembolism is a dreaded complication following microsurgical breast reconstruction. Although the high-risk nature of the procedure is well known, a thorough analysis of modifiable risk factors has not been performed. The purpose of this study was to analyze the association of such factors with the postoperative occurrence of venous thromboembolism longitudinally. Methods: Using the Truven MarketScan Database, a retrospective cohort study of women who underwent microsurgical breast reconstruction from 2007 to 2015 and who developed postoperative venous thromboembolism within 90 days of reconstruction was performed. Predictor variables included age, timing of reconstruction, body mass index, history of radiation therapy, history of venous thromboembolism, Elixhauser Comorbidity Index, and length of stay. Univariate analyses were performed, in addition to logistic and zero-inflated Poisson regressions, to evaluate predictors of venous thromboembolism and changes in venous thromboembolism over the study period, respectively. Results: Twelve thousand seven hundred seventy-eight women were identified, of which 167 (1.3 percent) developed venous thromboembolism. The majority of venous thromboembolisms (67.1 percent) occurred following discharge, with no significant change from 2007 to 2015. Significant predictors of venous thromboembolism included Elixhauser score (p < 0.01), history of venous thromboembolism (p < 0.03), and length of stay (p < 0.001). Compared to patients who developed a venous thromboembolism during the inpatient stay, patients who developed a postdischarge venous thromboembolism had a lower mean Elixhauser score (p < 0.001). Conclusions: Postoperative venous thromboembolism continues to be an inadequately addressed problem, as evidenced by a stable incidence over the study period. Identification of modifiable risk factors, such as length of stay, provides potential avenues for intervention. As the majority of venous thromboembolisms occur following discharge, future studies are warranted to investigate the role for an intervention in this period. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.

Ultrasound Surveillance Offers a Safe and Effective Method for Venous Thromboembolism Prevention in Plastic Surgery Patients

“…Five recent publications investigate venous thromboembolism (VTE) risk reduction [1][2][3][4][5]. Rochlin et al [1] analyzed a large database and conclude that the length of hospital stay is a modifiable risk factor in microsurgical breast reconstruction patients.…”

“…Five recent publications investigate venous thromboembolism (VTE) risk reduction [1][2][3][4][5]. Rochlin et al [1] analyzed a large database and conclude that the length of hospital stay is a modifiable risk factor in microsurgical breast reconstruction patients. However, these authors found no significant difference in VTE rates over time comparing patients treated during 2007-2009 with women treated during 2013-2015, despite the fact that patients treated during the earlier time frame had significantly longer hospital stays (4.36 days versus 4.13 days) [1].…”

“…Pannucci, the senior author of this review [1], has long championed Caprini scores and individual risk stratification [6,7]. Importantly, the length of hospital stay is not considered in a Caprini score [7,8].…”

“…Rochlin et al [1] suggest that shortening the hospital stay may be helpful in reducing VTE risk. This is a difficult thesis to prove because patients who are discharged sooner are also likely to be healthier.…”

“…Notably, four of the five studies do not discuss or reference ultrasound surveillance for VTE [1,2,4,5], although 4.5% of surveyed plastic surgeons report using this modality for screening and management [2]. Today, ultrasound applications in plastic surgery are a subject of intense interest [10][11][12][13][14].…”