Predicting Postoperative Recovery Following Intraoperative Microvascular Complications in Autologous Breast...

Intraoperative microvascular complications in autologous breast reconstruction may increase the risk of immediate postoperative flap complications, such as congestion, thrombosis, and flap loss. The impact of specific intraoperative complications on patient outcomes remains unclear.

A retrospective chart review of microsurgical breast reconstruction cases from 2017 to 2023 was performed to determine intraoperative and postoperative complications, as well as patient outcomes. Statistical analysis was conducted to determine associations between intraoperative complications and outcomes.

A total of 1,005 flaps were performed in 620 patients, with intraoperative complications experienced in 15.1% (152/1,005) flaps. Pedicle/perforator injury was the most common (5.3%). Difficult flap pedicle dissection was a predictor of the need for a blood transfusion (17.7% vs. 8.3%, OR: 2.4 [95% CI: 1.1-5.0], p = 0.04). Hematoma was not associated with any intraoperative complications. In comparison, postoperative flap ischemia was associated only with intraoperative arterial thrombosis (8.3% vs. 0.7%, OR: 2.8 [95% CI: 1.5-113.0], p = 0.003). Postoperative flap congestion was associated with both intraoperative complications of alternate venous outflow (40% vs. 1.9%, OR: 34.4 [95% CI: 5.4-218], p = 0.004) and pedicle/perforator injury (10.5% vs. 1.9%, OR: 6.0 [95% CI: 1.3-27.7], p = 0.01). Prolonged length of stay greater than the expected 3 days was associated with difficult flap pedicle vessel dissection (52.9% vs. 31.5%, OR: 2.4 [95% CI: 1.4-4.3], p = 0.001) and intraoperative arterial thrombosis (63.6% vs. 32.3%, OR: 3.7 [95% CI: 1.1-12.7], p = 0.04). Length of stay greater than 4 days was solely associated with intraoperative thrombosis (36.4% vs. 9.9%, OR: 5.4 [1.6-18.7], p = 0.019). The intraoperative complications of venous anastomosis revision and difficult internal mammary vessel dissection had no significant association with the postoperative course.

Specific intraoperative complications are associated with higher rates of postoperative complications. Awareness of the tendency for a complex postoperative recovery is warranted.