National Trends and Impact of Preoperative CT-Angiography on Autologous Breast Reconstruction

Prior studies investigating the impact of preoperative computed tomography (CT)-angiography (pCTA) on outcomes for autologous breast reconstruction (ABR) have had conflicting results, in part because they have been largely limited to single-center studies with limited sample size. Larger, nationwide studies are needed to better understand the trends and outcomes associated with pCTA for ABR.

Using ICD-9/CPT codes, we identified patients who underwent ABR with and without pCTA between 2010 and 2022 in a national administrative claims database; 90-day complication rates, costs, length of hospital stay (LOS), and trends in usage of pCTA were evaluated.

Of 6372 ABR patients, 4059 (63.7%) did not undergo pCTA and 2313 (36.3%) underwent pCTA. ABR patients with (versus without) pCTA generally had delayed (versus immediate) ABR and a higher body mass index (BMI) and other comorbidities. Annual rate of pCTAs increased from 30% in 2010 to 43% in 2022. No difference in 90-day outcomes, hospital costs, or LOS was observed in patients undergoing ABR with or without pCTA in multivariable regression analysis.

The use of pCTA for ABR has been gradually rising nationwide and is preferentially used in ABR patients with a generally higher burden of comorbidities. However, despite this growing trend, there appears to be no difference in 90-day outcomes, hospital costs, or LOS between patients undergoing ABR with or without pCTA. Use of pCTA should be carefully considered to avoid unnecessary expense and risks for ABR patients. Additional studies are needed to establish standardized protocols to determine which ABR patients would most benefit from pCTA use.