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The Impact Of Perioperative Vasopressors On Flap Outcomes In Autologous Breast Reconstruction: A Propensity-score Match Analysis
Maria J. Escobar Domingo, MD, Agustin Posso, MD, Audrey Mustoe, BA, Micaela Tobin, BA, Morvarid Mehdizadeh, BA, Chamilka Merle, MD, Sarah J. Karinja, MD, Bernard T. Lee, MD, MBA, MPH.
Beth Israel Deaconess Medical Center, Boston, MA, USA.
PURPOSE: The use of perioperative vasopressors (VP) in free flaps has long been controversial. This study aimed to evaluate the postoperative outcomes associated with VP use in breast cancer patients undergoing autologous breast reconstruction (ABR).
METHODS:A multicenter retrospective analysis was conducted using TriNetX to identify breast cancer patients who underwent ABR. Patients were divided into two cohorts based on use of VP on the day of surgery versus no VP use. One-to-one nearest-neighbor propensity score matching was performed to adjust for baseline differences. The primary outcomes included flap failure, need for secondary free flap procedures, blood vessel repair, and other flap revisions. Surgical and clinical complications, as well as healthcare utilization within 90 days postoperatively, were also assessed. Group differences were analyzed using t-tests, chi-square tests, and logistic regression models.
RESULTS:After propensity score matching, 4812 patients were analyzed, with 50% in each group. VP use was associated with a higher risk of reoperation due to revision of the anastomosis (RR1.63;95% CI,1.02-2.60;p=0.040). No significant differences were observed in flap failure, secondary flap procedures, or other revisions. However, VP use was associated with increased risks of postoperative hematoma/seroma (RR1.51;95% CI,1.10-2.07;p=0.010), surgical site infection (RR2.52;95% CI,1.80-3.52;p<0.001), rehospitalization (RR1.20;95% CI,1.02-1.40;p=0.027), and deep venous thrombosis (RR1.76;95% CI,1.07-2.91;p=0.025).
CONCLUSION:While VP use does not increase flap failure rates, it is associated with higher risks of reoperation, rehospitalization, and hematoma in ABR.
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