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Predictive risk factors of free flap thrombosis in breast reconstruction surgery
Vascular thrombosis is one of the major postoperative complications of free flap microvascular breast reconstruction operations. It is associated with higher morbidity, higher cost, increased length of hospital stay, and potentially flap loss. Our purpose is to evaluate the rate of this complication...
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| Published in: | Microsurgery 2014-11, Vol.34 (8), p.589-594 |
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| container_title | Microsurgery |
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| creator | Masoomi, Hossein Clark, Emily G. Paydar, Keyianoosh Z. Evans, Gregory R.D. Nguyen, Audrey Kobayashi, Mark R. Wirth, Garrett A. |
| description | Vascular thrombosis is one of the major postoperative complications of free flap microvascular breast reconstruction operations. It is associated with higher morbidity, higher cost, increased length of hospital stay, and potentially flap loss. Our purpose is to evaluate the rate of this complication and whether patient characteristics play a role. Using the Nationwide Inpatient Sample (NIS) database, we examined the clinical data of patients who underwent free flap breast reconstruction between 2009 and 2010 in the United States. Multivariate and univariate regression analyses were performed to identify independent risk factors of flap thrombosis. A total of 15,211 patients underwent free flap breast reconstruction surgery (immediate reconstruction: 43%). The most common flap was the free deep inferior epigastric perforator (DIEP) flap (53.6%), followed by free transverse rectus abdominis myocutaneous (TRAM) flap (43.1%), free superficial inferior epigastric artery (SIEA) flap (2%), and free gluteal artery perforator (GAP) flap (1.3%). The overall rate of flap thrombosis was 2.4 %, with the highest rate seen in the SIEA group (11.4%) and the lowest in the TRAM group (1.7%). Peripheral vascular disease (adjusted odds ration [AOR] 10.61), SIEA flap (AOR, 4.76) and delayed reconstruction (AOR, 1.42) were found to be statistically significant risk factors for flap thrombosis. Other comorbidities were not linked. While the overall rate of flap thrombosis in free flap breast reconstruction was relatively low (2.4%), Plastic Surgeons should be aware that patients with peripheral vascular disease and those undergoing free SIEA flap are at higher risk of flap thrombosis and they should closely monitor flaps to increase the chance for early salvage. © 2014 Wiley Periodicals, Inc. Microsurgery 34:589–594, 2014. |
| doi_str_mv | 10.1002/micr.22250 |
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It is associated with higher morbidity, higher cost, increased length of hospital stay, and potentially flap loss. Our purpose is to evaluate the rate of this complication and whether patient characteristics play a role. Using the Nationwide Inpatient Sample (NIS) database, we examined the clinical data of patients who underwent free flap breast reconstruction between 2009 and 2010 in the United States. Multivariate and univariate regression analyses were performed to identify independent risk factors of flap thrombosis. A total of 15,211 patients underwent free flap breast reconstruction surgery (immediate reconstruction: 43%). The most common flap was the free deep inferior epigastric perforator (DIEP) flap (53.6%), followed by free transverse rectus abdominis myocutaneous (TRAM) flap (43.1%), free superficial inferior epigastric artery (SIEA) flap (2%), and free gluteal artery perforator (GAP) flap (1.3%). The overall rate of flap thrombosis was 2.4 %, with the highest rate seen in the SIEA group (11.4%) and the lowest in the TRAM group (1.7%). Peripheral vascular disease (adjusted odds ration [AOR] 10.61), SIEA flap (AOR, 4.76) and delayed reconstruction (AOR, 1.42) were found to be statistically significant risk factors for flap thrombosis. Other comorbidities were not linked. While the overall rate of flap thrombosis in free flap breast reconstruction was relatively low (2.4%), Plastic Surgeons should be aware that patients with peripheral vascular disease and those undergoing free SIEA flap are at higher risk of flap thrombosis and they should closely monitor flaps to increase the chance for early salvage. © 2014 Wiley Periodicals, Inc. Microsurgery 34:589–594, 2014.</description><identifier>ISSN: 0738-1085</identifier><identifier>EISSN: 1098-2752</identifier><identifier>DOI: 10.1002/micr.22250</identifier><identifier>PMID: 24665051</identifier><language>eng</language><publisher>United States: Blackwell Publishing Ltd</publisher><subject>Adult ; Age Factors ; Aged ; Aged, 80 and over ; Breast Diseases - complications ; Breast Diseases - pathology ; Breast Diseases - surgery ; Female ; Hospitalization - statistics & numerical data ; Humans ; Mammaplasty - adverse effects ; Mammaplasty - statistics & numerical data ; Middle Aged ; Retrospective Studies ; Risk Factors ; Surgical Flaps - adverse effects ; Surgical Flaps - blood supply ; Surgical Flaps - statistics & numerical data ; Thrombosis - epidemiology ; Time Factors ; United States ; Young Adult</subject><ispartof>Microsurgery, 2014-11, Vol.34 (8), p.589-594</ispartof><rights>2014 Wiley Periodicals, Inc.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4650-af78c5b76d20dbe47c5d79d9f4aec49d8e7627e8b337ea2a697f7fcf77d43133</citedby><cites>FETCH-LOGICAL-c4650-af78c5b76d20dbe47c5d79d9f4aec49d8e7627e8b337ea2a697f7fcf77d43133</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1002%2Fmicr.22250$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1002%2Fmicr.22250$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>315,786,790,27957,27958,50923,51032</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/24665051$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Masoomi, Hossein</creatorcontrib><creatorcontrib>Clark, Emily G.</creatorcontrib><creatorcontrib>Paydar, Keyianoosh Z.</creatorcontrib><creatorcontrib>Evans, Gregory R.D.</creatorcontrib><creatorcontrib>Nguyen, Audrey</creatorcontrib><creatorcontrib>Kobayashi, Mark R.</creatorcontrib><creatorcontrib>Wirth, Garrett A.</creatorcontrib><title>Predictive risk factors of free flap thrombosis in breast reconstruction surgery</title><title>Microsurgery</title><addtitle>Microsurgery</addtitle><description>Vascular thrombosis is one of the major postoperative complications of free flap microvascular breast reconstruction operations. It is associated with higher morbidity, higher cost, increased length of hospital stay, and potentially flap loss. Our purpose is to evaluate the rate of this complication and whether patient characteristics play a role. Using the Nationwide Inpatient Sample (NIS) database, we examined the clinical data of patients who underwent free flap breast reconstruction between 2009 and 2010 in the United States. Multivariate and univariate regression analyses were performed to identify independent risk factors of flap thrombosis. A total of 15,211 patients underwent free flap breast reconstruction surgery (immediate reconstruction: 43%). The most common flap was the free deep inferior epigastric perforator (DIEP) flap (53.6%), followed by free transverse rectus abdominis myocutaneous (TRAM) flap (43.1%), free superficial inferior epigastric artery (SIEA) flap (2%), and free gluteal artery perforator (GAP) flap (1.3%). The overall rate of flap thrombosis was 2.4 %, with the highest rate seen in the SIEA group (11.4%) and the lowest in the TRAM group (1.7%). Peripheral vascular disease (adjusted odds ration [AOR] 10.61), SIEA flap (AOR, 4.76) and delayed reconstruction (AOR, 1.42) were found to be statistically significant risk factors for flap thrombosis. Other comorbidities were not linked. While the overall rate of flap thrombosis in free flap breast reconstruction was relatively low (2.4%), Plastic Surgeons should be aware that patients with peripheral vascular disease and those undergoing free SIEA flap are at higher risk of flap thrombosis and they should closely monitor flaps to increase the chance for early salvage. © 2014 Wiley Periodicals, Inc. Microsurgery 34:589–594, 2014.</description><subject>Adult</subject><subject>Age Factors</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Breast Diseases - complications</subject><subject>Breast Diseases - pathology</subject><subject>Breast Diseases - surgery</subject><subject>Female</subject><subject>Hospitalization - statistics & numerical data</subject><subject>Humans</subject><subject>Mammaplasty - adverse effects</subject><subject>Mammaplasty - statistics & numerical data</subject><subject>Middle Aged</subject><subject>Retrospective Studies</subject><subject>Risk Factors</subject><subject>Surgical Flaps - adverse effects</subject><subject>Surgical Flaps - blood supply</subject><subject>Surgical Flaps - statistics & numerical data</subject><subject>Thrombosis - epidemiology</subject><subject>Time Factors</subject><subject>United States</subject><subject>Young Adult</subject><issn>0738-1085</issn><issn>1098-2752</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2014</creationdate><recordtype>article</recordtype><recordid>eNp9kM1u1DAURi0EokNhwwMgS2wQUop_YjteohGUigIDqoTUjeU41-A2iYfrBJi3J8O0XbBg5c35zrUOIU85O-GMiVdDCngihFDsHllxZptKGCXukxUzsqk4a9QReVTKFWPMWmMfkiNRa62Y4iuy2SB0KUzpJ1BM5ZpGH6aMheZIIwLQ2Pstnb5jHtpcUqFppC2CLxNFCHksE87LOo-0zPgNcPeYPIi-L_Dk5j0mF2_fXKzfVeefTs_Wr8-rUC-nKx9NE1RrdCdY10JtguqM7WysPYTadg0YLQw0rZQGvPDammhiiMZ0teRSHpMXB-0W848ZyuSGVAL0vR8hz8VxzZlRi0Iv6PN_0Ks847h8bqGYFYZJuadeHqiAuRSE6LaYBo87x5nbZ3b7zO5v5gV-dqOc2wG6O_S26wLwA_Ar9bD7j8p9OFt_uZVWh00qE_y-23i8dtpIo9zXj6fuUojN5Wep3Xv5Bz26l2c</recordid><startdate>201411</startdate><enddate>201411</enddate><creator>Masoomi, Hossein</creator><creator>Clark, Emily G.</creator><creator>Paydar, Keyianoosh Z.</creator><creator>Evans, Gregory R.D.</creator><creator>Nguyen, Audrey</creator><creator>Kobayashi, Mark R.</creator><creator>Wirth, Garrett A.</creator><general>Blackwell Publishing Ltd</general><general>Wiley Subscription Services, Inc</general><scope>BSCLL</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QO</scope><scope>7T5</scope><scope>7T7</scope><scope>7TK</scope><scope>8FD</scope><scope>C1K</scope><scope>FR3</scope><scope>H94</scope><scope>K9.</scope><scope>P64</scope><scope>7X8</scope></search><sort><creationdate>201411</creationdate><title>Predictive risk factors of free flap thrombosis in breast reconstruction surgery</title><author>Masoomi, Hossein ; Clark, Emily G. ; Paydar, Keyianoosh Z. ; Evans, Gregory R.D. ; Nguyen, Audrey ; Kobayashi, Mark R. ; Wirth, Garrett A.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4650-af78c5b76d20dbe47c5d79d9f4aec49d8e7627e8b337ea2a697f7fcf77d43133</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2014</creationdate><topic>Adult</topic><topic>Age Factors</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Breast Diseases - complications</topic><topic>Breast Diseases - pathology</topic><topic>Breast Diseases - surgery</topic><topic>Female</topic><topic>Hospitalization - statistics & numerical data</topic><topic>Humans</topic><topic>Mammaplasty - adverse effects</topic><topic>Mammaplasty - statistics & numerical data</topic><topic>Middle Aged</topic><topic>Retrospective Studies</topic><topic>Risk Factors</topic><topic>Surgical Flaps - adverse effects</topic><topic>Surgical Flaps - blood supply</topic><topic>Surgical Flaps - statistics & numerical data</topic><topic>Thrombosis - epidemiology</topic><topic>Time Factors</topic><topic>United States</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Masoomi, Hossein</creatorcontrib><creatorcontrib>Clark, Emily G.</creatorcontrib><creatorcontrib>Paydar, Keyianoosh Z.</creatorcontrib><creatorcontrib>Evans, Gregory R.D.</creatorcontrib><creatorcontrib>Nguyen, Audrey</creatorcontrib><creatorcontrib>Kobayashi, Mark R.</creatorcontrib><creatorcontrib>Wirth, Garrett A.</creatorcontrib><collection>Istex</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Biotechnology Research Abstracts</collection><collection>Immunology Abstracts</collection><collection>Industrial and Applied Microbiology Abstracts (Microbiology A)</collection><collection>Neurosciences Abstracts</collection><collection>Technology Research Database</collection><collection>Environmental Sciences and Pollution Management</collection><collection>Engineering Research Database</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>MEDLINE - Academic</collection><jtitle>Microsurgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Masoomi, Hossein</au><au>Clark, Emily G.</au><au>Paydar, Keyianoosh Z.</au><au>Evans, Gregory R.D.</au><au>Nguyen, Audrey</au><au>Kobayashi, Mark R.</au><au>Wirth, Garrett A.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Predictive risk factors of free flap thrombosis in breast reconstruction surgery</atitle><jtitle>Microsurgery</jtitle><addtitle>Microsurgery</addtitle><date>2014-11</date><risdate>2014</risdate><volume>34</volume><issue>8</issue><spage>589</spage><epage>594</epage><pages>589-594</pages><issn>0738-1085</issn><eissn>1098-2752</eissn><notes>ark:/67375/WNG-Z22PZQ36-K</notes><notes>ArticleID:MICR22250</notes><notes>istex:3AF571069F69775DD720455B8FA4A702D7E91FB3</notes><notes>Presented in the Plenary Session at the American Society for Reconstructive Microsurgery Annual Meeting, January 14, 2013, at the Grand Hyatt Kauai Resort & Spa, Kauai, Hawaii</notes><notes>ObjectType-Article-1</notes><notes>SourceType-Scholarly Journals-1</notes><notes>ObjectType-Feature-2</notes><notes>content type line 23</notes><abstract>Vascular thrombosis is one of the major postoperative complications of free flap microvascular breast reconstruction operations. It is associated with higher morbidity, higher cost, increased length of hospital stay, and potentially flap loss. Our purpose is to evaluate the rate of this complication and whether patient characteristics play a role. Using the Nationwide Inpatient Sample (NIS) database, we examined the clinical data of patients who underwent free flap breast reconstruction between 2009 and 2010 in the United States. Multivariate and univariate regression analyses were performed to identify independent risk factors of flap thrombosis. A total of 15,211 patients underwent free flap breast reconstruction surgery (immediate reconstruction: 43%). The most common flap was the free deep inferior epigastric perforator (DIEP) flap (53.6%), followed by free transverse rectus abdominis myocutaneous (TRAM) flap (43.1%), free superficial inferior epigastric artery (SIEA) flap (2%), and free gluteal artery perforator (GAP) flap (1.3%). The overall rate of flap thrombosis was 2.4 %, with the highest rate seen in the SIEA group (11.4%) and the lowest in the TRAM group (1.7%). Peripheral vascular disease (adjusted odds ration [AOR] 10.61), SIEA flap (AOR, 4.76) and delayed reconstruction (AOR, 1.42) were found to be statistically significant risk factors for flap thrombosis. Other comorbidities were not linked. While the overall rate of flap thrombosis in free flap breast reconstruction was relatively low (2.4%), Plastic Surgeons should be aware that patients with peripheral vascular disease and those undergoing free SIEA flap are at higher risk of flap thrombosis and they should closely monitor flaps to increase the chance for early salvage. © 2014 Wiley Periodicals, Inc. Microsurgery 34:589–594, 2014.</abstract><cop>United States</cop><pub>Blackwell Publishing Ltd</pub><pmid>24665051</pmid><doi>10.1002/micr.22250</doi><tpages>6</tpages></addata></record> |
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| subjects | Adult Age Factors Aged Aged, 80 and over Breast Diseases - complications Breast Diseases - pathology Breast Diseases - surgery Female Hospitalization - statistics & numerical data Humans Mammaplasty - adverse effects Mammaplasty - statistics & numerical data Middle Aged Retrospective Studies Risk Factors Surgical Flaps - adverse effects Surgical Flaps - blood supply Surgical Flaps - statistics & numerical data Thrombosis - epidemiology Time Factors United States Young Adult |
| title | Predictive risk factors of free flap thrombosis in breast reconstruction surgery |
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