Impact of Blood Transfusion in Free Flap Breast Reconstruction Using Propensity Score Matching.

Area of Science:

• Plastic Surgery
• Surgical Oncology
• Transfusion Medicine

Background:

• Microvascular thrombosis linked to cytokine release and inflammatory syndromes can follow blood transfusions.
• These transfusion-related inflammatory responses may complicate breast free flap reconstruction.
• Evaluating the impact of perioperative blood transfusion on free flap breast reconstruction outcomes is crucial.

Purpose of the Study:

• To assess the association between perioperative blood transfusion and outcomes in free flap breast reconstruction.
• To determine if blood transfusions increase the risk of flap-related complications or reoperation.
• To analyze the impact of transfusions on other systemic postoperative complications.

Main Methods:

• Analysis of the American College of Surgeons National Quality Improvement Program database for delayed free flap breast reconstructions in 2016.
• Comparison of outcomes between patients receiving perioperative blood transfusion and those who did not, using propensity score matching.
• Primary outcome: unplanned return to the operating room (OR) within 30 days. Secondary outcomes: readmission and complications.

Main Results:

• A total of 1,256 patients were analyzed; 91 received one unit of packed red blood cells (PRBC) perioperatively.
• Transfused patients showed a significantly higher reoperation rate (42% vs. 10%, p < 0.001), primarily due to flap complications.
• Perioperative transfusion increased wound dehiscence (9% vs. 2%, p = 0.041) but did not reduce other postoperative complications.

Conclusions:

• Perioperative blood transfusion in free flap breast reconstruction is linked to a higher likelihood of flap-related complications.
• Transfusions are associated with an increased probability of returning to the OR for flap issues.
• Blood transfusions did not decrease the incidence of other systemic postoperative complications in this patient group.