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Timing Of Microvascular Flap Compromise In Autologous Breast Reconstruction: Implications For Hospital Length Of Stay
Rebecca Lee Vernon, MD, Kshipra Hemal, MD, John Muller, MD, Carter Boyd, MD, Thomas Sorenson, MD, Angela Volk, MD, Sachin Chinta, BS, Alay Shah, MD, Mihye Choi, MD, Oriana Cohen, MD, Nolan Karp, MD, Jamie P. Levine, MD, Vishal Thanik, MD, Katie Weichman, MD.
New York University Langone Health, New York, NY, USA.
Purpose: Prompt identification of microvascular compromise and rapid return to the operating room are associated with higher rates of flap salvage. We sought to characterize the timing of microvascular compromise in autologous breast reconstruction to minimize the risk of flap loss in the face of increasingly early hospital discharge.
Methods: A retrospective review of 338 patients (540 breasts) who underwent autologous breast reconstruction (2017-2021) was conducted at a single institution. The incidence of arterial/venous compromise, time to compromise, return to the operating room, rate of flap loss, and length of stay were reviewed.
Results: There were 10(1.9%) cases of microvascular compromise, including 3(0.6%) cases of arterial compromise, 6(1.1%) cases of venous compromise, and 1(0.2%) case of combined arterial and venous compromise. Nine patients (2.7%) experienced microvascular compromise requiring return to the operating room. Time to flap compromise ranged from 1 - 86 hours, with most cases (80%) occurring within 24 hours (
Figure 1). Among patients who experienced flap compromise, length of stay ranged from 3-7 days. There were 2(0.4%) cases of total flap loss, which occurred at 60 and 86 hours.
Conclusions: The incidence of microvascular compromise in our cohort was low (1.9%). All but 2 cases occurred within 24 hours postoperatively. These findings suggest that for most patients, discharge prior to postoperative day three is safe and could reduce hospital length of stay.
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