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Predictive Risk Factors of Venous Thromboembolism in Autologous Breast Reconstruction Surgery
Hossein Masoomi, MD1, Keyianoosh Paydar, MD, FACS2, Garrett A. Wirth, MD, FACS2, Al Aly, MD, FACS2, Gregory R.D. Evans, MD, FACS2.
1University of California, Irvine; Department of Surgery, Orange, CA, USA, 2Aesthetic & of Plastic Surgery Institute, University of California, Irvine, Orange, CA, USA.
PURPOSE: Venous thromboembolism (VTE) can be a significant cause of morbidity and mortality in autologus breast reconstruction surgery. The aim of this study was to evaluate the effect of patient characteristics, comorbidities, payer-type, reconstruction-type, reconstruction-timing, radiation, chemotherapy and teaching status of hospital on VTE (deep venous thrombosis and/or pulmonary embolism) in autologous breast reconstructive surgery.
METHODS: Using the Nationwide Inpatient Sample (NIS) database, we examined the clinical data of patients who underwent autologous breast reconstructive surgery from 2009 to 2010 in the United States. Univariate and multivariate regression analyses were performed to identify factors predictive of in-hospital VTE.
RESULTS: A total of 35,883 patients underwent autologous breast reconstructive surgery during these two years. Overall rate of VTE was 0.13%. The highest rate of VTE (0.26%) was observed in pedicled transverse rectus abdominis myocutaneous (TRAM) flap. Patients who experienced VTE had significantly longer mean hospital stay (11.6 days vs. 3.9 days; P<0.001) and higher mean total hospital charges ($146,432 vs. $61,794; P<0.001) compared with non-VTE patients; however, there was no significant difference observed in mortality rate (VTE: 0.0% vs. non-VTE: 0.04%; P=0.886). Using multivariate regression analysis, immediate reconstruction after mastectomy (adjusted odds ratio [AOR]: 5.4), age over 65 (AOR: 4.2), history of chemotherapy (AOR: 3.5), obesity (AOR: 3.7) and chronic lung disease (AOR: 2.5) were associated with higher risk of VTE. There was no association between race, payer-type, diabetes, hypertension, liver disease, congestive heart failure, peripheral vascular disease, chronic kidney disease, smoking, reconstruction-type, radiation or teaching status of hospital on VTE. CONCLUSION: In patients undergoing autologus breast reconstruction surgery, immediate reconstruction, age over 65, history of chemotherapy, obesity and chronic lung disease are all independent predictors of higher VTE. Surgeon should consider these factors and use appropriate prophylaxis to minimize the risk of VTE development.
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