Outcomes of Free-Flap Breast Reconstruction With Vasopressor Use: A Database-Driven Propensity Score-Matched Analysis

Area of Science:

• Microsurgery
• Plastic and reconstructive surgery
• Oncology

Background:

• Autologous breast reconstruction using free tissue transfer is a key treatment for breast cancer patients.
• The use of vasopressors for hemodynamic management during free flap surgery is debated due to potential risks to flap viability.
• Existing research on vasopressor effects on microsurgical outcomes is inconclusive.

Purpose of the Study:

• To analyze the outcomes of free-flap breast reconstruction in patients who received perioperative vasopressors versus those who did not.
• To investigate the impact of vasopressor use on flap complications and other adverse events.

Main Methods:

• A retrospective analysis of the TriNetX National Health Research database (2004-2024) identified patients undergoing free-flap breast reconstruction.
• Two matched cohorts were created: one receiving vasopressors within 5 days of surgery and one not.
• Flap complications (anastomosis revision, vessel repair, flap revision), sepsis, venous thromboembolism, and hematoma evacuation were assessed using diagnosis and procedural codes.

Main Results:

• Of 15,548 patients, 8,392 received vasopressors and 7,156 did not; matched cohorts comprised 6,416 patients each.
• The vasopressor group had a significantly lower rate of primary flap complications (14.4% vs. 16.0%, P=0.011).
• No significant difference was found in the total complication rate (16.6% vs. 17.5%, P=0.084) when considering all primary and secondary outcomes.

Conclusions:

• Perioperative vasopressor administration does not significantly increase the overall complication rate in autologous free-flap breast reconstruction.
• A lower rate of flap-specific complications was observed in patients who received vasopressors.
• Vasopressor use appears safe and potentially beneficial when clinically indicated for patients undergoing free-flap breast reconstruction.