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

Publication ,  Journal Article
Orr, JP; Shammas, RL; Thomas, AB; Truong, T; Cho, EH; Kuchibhatla, M; Hollenbeck, ST
Published in: J Reconstr Microsurg
July 2019

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.

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Published In

J Reconstr Microsurg

DOI

EISSN

1098-8947

Publication Date

July 2019

Volume

35

Issue

6

Start / End Page

417 / 424

Location

United States

Related Subject Headings

  • Surgery
  • Risk Assessment
  • Retrospective Studies
  • Quality Improvement
  • Postoperative Hemorrhage
  • Middle Aged
  • Mastectomy
  • Mammaplasty
  • Incidence
  • Humans
 

Citation

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ICMJE
MLA
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Orr, J. P., Shammas, R. L., Thomas, A. B., Truong, T., Cho, E. H., Kuchibhatla, M., & Hollenbeck, S. T. (2019). Bleeding After Free Flap-Based Breast Reconstruction: A NSQIP Analysis. J Reconstr Microsurg, 35(6), 417–424. https://doi.org/10.1055/s-0038-1677037
Orr, Jonah Parker, Ronnie Labib Shammas, Analise B. Thomas, Tracy Truong, Eugenia H. Cho, Maragatha Kuchibhatla, and Scott Thomas Hollenbeck. “Bleeding After Free Flap-Based Breast Reconstruction: A NSQIP Analysis.J Reconstr Microsurg 35, no. 6 (July 2019): 417–24. https://doi.org/10.1055/s-0038-1677037.
Orr JP, Shammas RL, Thomas AB, Truong T, Cho EH, Kuchibhatla M, et al. Bleeding After Free Flap-Based Breast Reconstruction: A NSQIP Analysis. J Reconstr Microsurg. 2019 Jul;35(6):417–24.
Orr, Jonah Parker, et al. “Bleeding After Free Flap-Based Breast Reconstruction: A NSQIP Analysis.J Reconstr Microsurg, vol. 35, no. 6, July 2019, pp. 417–24. Pubmed, doi:10.1055/s-0038-1677037.
Orr JP, Shammas RL, Thomas AB, Truong T, Cho EH, Kuchibhatla M, Hollenbeck ST. Bleeding After Free Flap-Based Breast Reconstruction: A NSQIP Analysis. J Reconstr Microsurg. 2019 Jul;35(6):417–424.
Journal cover image

Published In

J Reconstr Microsurg

DOI

EISSN

1098-8947

Publication Date

July 2019

Volume

35

Issue

6

Start / End Page

417 / 424

Location

United States

Related Subject Headings

  • Surgery
  • Risk Assessment
  • Retrospective Studies
  • Quality Improvement
  • Postoperative Hemorrhage
  • Middle Aged
  • Mastectomy
  • Mammaplasty
  • Incidence
  • Humans