A National Data-Driven Approach to Optimizing Monitoring of Autologous Breast Free Flap Reconstruction: Analysis of 3,666 Patients
Pablo Baltodano, MD1, Grant N. Schalet, BA2, Oluseyi Aliu, MD1, Maxie Weinberg, BS1, Ashar Ata, MPH, PhD3, Kristen Rezak, MD1, Richard L. Agag, MD1, Ashit Patel, MD1.
1Division of Plastic Surgery, Albany Medical Center, Albany, NY, USA, 2Albany Medical College, Albany, NY, USA, 3Department of Surgery, Albany Medical Center, Albany, NY, USA.
Purpose: We aimed to determine the rates and independent predictors of free flap compromise requiring reoperation after autologous breast reconstruction.
Methods: Retrospective review of the relevant ACS-NSQIP 2012-2014 prospectively collected data. We performed multivariable logistic regression analysis to determine independent predictors of unplanned reoperation.
Results: Inpatient status, obesity (BMI ≥30.0), hypertension, American Society of Anesthesiology (ASA) class ≥3, and smoking were independent predictors of unplanned reoperation (all p<0.05, Table 1). Of the 3,666 patient cohort, 4.7% required reoperation between the end of surgery and end of POD1, 1.1% required reoperation during POD2 (Figure 1). Risk factors did not significantly increase the likelihood of reoperation on POD2: a comparable proportion of patients with risk factors (0.6%) underwent reoperation as compared to those without risk factors (0.5%). Daily reoperation rates were consistently low after POD2 (Figure 2).
Conclusion: Given the low rate of breast free flap compromise following POD2, providers may consider discontinuing monitoring after the first 48 hours. By exerting more judicious post-operative management for these patients, providers can generate tremendous savings for the health care system.
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