Impact of Judicious Fluid Administration in the Setting of Abdominally Based Free Flaps

Abstract: Background: Abdominally based free flaps are commonly utilized in the context of breast reconstruction. Historically, postoperative care of these patients involved liberal amounts of intravenous fluid administration; however, over-administration of fluids puts patients at risk of developing flap edema via fluid shifts, electrolyte imbalances, wound dehiscence, and other sequelae. The purpose of this study is to assess fluid administration trends in this cohort at the authors’ institution and assess its impact on patient outcomes. Materials: A retrospective review was performed on patients who underwent free-flap breast reconstruction. Patient demographics and hospitalization data were collected, and type of abdominal flap and reconstruction timing was noted. Perioperative fluid administration volumes were tracked, and primary outcomes included complication rate and type (e.g. acute blood loss anemia (ABLA), partial/total flap loss, etc). Multivariable logistic regression was performed to assess the impact of fluid volume on patient outcomes. Results: A total of 115 patients (mean age of 51.3 ± 10.5 years) underwent 188 abdominally based free flaps. Deep inferior epigastric artery perforator flaps were performed most often (n = 91), followed by muscle-sparing transverse rectus abdominis flaps (n = 88). Multivariable logistic regression demonstrated that high perioperative fluid administration (≥9000mL) was associated with increased odds of medical complications (OR =21.7; CI 5.54–84.5; p<0.001). Patients with high fluid administration volumes experienced an increased (but non-statistically significant) flap complication rate (OR= 2.96; CI 0.89–9.88; p=0.08) and developed ABLA at a higher rate (OR = 15.86; CI 5.30–46.4; p<0.001). Conclusion: High volume resuscitation (≥9000mL) was associated with increased odds of ABLA as well as a greater likelihood of medical and flap complications in patients undergoing abdominally based free flaps for breast reconstruction. This data should be used to guide the development of protocols within institutions which perform free flaps for breast reconstruction.

Publication History

Received: 19 December 2024

Accepted after revision: 12 May 2025

Accepted Manuscript online:
20 May 2025