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Microsurgical Breast Reconstruction Clinical Outcomes In The COVID-19 Era
Victor Z. Zhu, MD, MHS, Robert P. Duggan, BS, Julie E. Park, MD, Linda G. Phillips, MD.
University of Texas Medical Branch, Galveston, TX, USA.

PURPOSE: COVID-19 has led to major disruptions in plastic surgery care. Microsurgical breast reconstruction has arguably been affected the most as the procedure is subject to COVID-19 elective surgery bans and often competes for limited intensive care unit beds and nursing staff. Additionally, hypercoagulopathy and vasculitis are known manifestations of COVID-19, which can increase risk for microsurgical vessel anastomosis failure. This study seeks to determine if the COVID-19 pandemic has led to poorer clinical outcomes in microsurgical breast reconstruction due to limited healthcare resources or complications of COVID-19 infection.
METHODS: A retrospective, multi-institutional study was conducted using the TriNetX research database, which includes de-identified patient records from 55 healthcare organizations across the United States. Clinical outcomes from microsurgical breast reconstruction patients who had any history of COVID-19 infection and underwent surgery from 3/11/2020-7/31/2021 were compared with a historical control of microsurgical breast reconstruction patients who underwent surgery from 3/11/2018-7/31/2019.
RESULTS: 1309 patients had a history of COVID-19 infection and underwent microsurgical breast reconstruction; 2195 patients were included in the historical control. COVID-19 breast reconstruction patients were found to have a higher risk of re-operation within 30 days (OR1.57, p<0.01), vascular complications/flap failure (OR1.52, p=0.02), need for additional vascular procedures (OR1.74, p=0.02), wound dehiscence (OR1.34, p=0.01), and need for revision wound closures (OR2.22, p<0.01). No significant differences were found in venous thromboembolism/pulmonary embolism, infection, and hematoma/seroma between the two groups.
CONCLUSION: Microsurgical breast reconstruction during COVID-19 is at increased risk for complications. Surgeons should proceed with caution with these procedures.


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