Abstract
Background Venous thromboembolism (VTE) is a significant cause of postoperative morbidity and
a focus of patient safety initiatives. Despite giving appropriate prophylaxis in accordance
with the Caprini risk assessment model, we observed a high incidence of VTE in patients
undergoing microsurgical breast reconstruction at our institution. To explore factors
contributing to these events, we compared patients undergoing microsurgical breast
reconstruction who sustained postoperative VTEs to those who did not.
Methods A retrospective review of all patients who underwent microsurgical free flap breast
reconstruction at Montefiore Medical Center from January 2009 to January 2016 was
conducted. Patients were divided into two cohorts; those sustaining postoperative
VTE and those who did not. Patients were compared based on demographics, comorbidities,
operative time, estimated intraoperative blood loss, need for transfusion, volume
of transfusion, and discharge on postoperative aspirin.
Results A total of 133 patients underwent microsurgical breast reconstruction during the
study period. Nine patients (6.8%) had postoperative VTE and there was one (0.8%)
death. Patients having VTE were more likely to be Hispanic (33.3%, n = 3) in the VTE group versus 8.1% (n = 6) in the control group (p = 0.011), more likely to have an increased mean transfusion volume (455.5 ± 367.8
vs. 139.51 ± 221.7 mL, p = 0.03), and were more likely to be discharged without aspirin (77.8%, n = 7 and 58.1%, n = 72; p = 0.003).
Conclusion Patients sustaining postoperative VTE after microsurgical breast reconstruction are
more likely to have an increased volume of blood transfusions and lack of discharge
on postoperative aspirin.
Keywords
breast reconstruction - venous thromboembolism - microsurgery
