Evaluation of 30-Days Venous Thromboembolism (VTE) Following Autologous Breast Reconstruction

Venous thromboembolism (VTE) is one of the known medical complications in autologous breast reconstruction (ABR) which is associated with a short and long-term morbidity as well as mortality. Identifying VTE risk factors is crucial for appropriate VTE prophylaxis measurements to lower this complication following ABR.

Using American College of Surgeons National Surgery Quality Improvement Project database, we examined the clinical data of patients who underwent ABR from 2016-2020 in the US. The frequency of VTE, day of occurrences and risk factors associated with VTE were evaluated.

Overall, 11,847 patients underwent ABR in the study period. The overall VTE rate was 1.0%. Totally 117 patients experienced VTE with a total occurrence of 127. Postoperative day 1 and 2 were reported with the highest frequency of VTE (21/127). Using multivariate regression analysis, independent risk factors associated with a higher VTE rate were length of hospital stay>=5 d [adjusted odd's ratio (AOR), 3.29], operative time longer than 10 h (AOR,2.17), and immediate reconstruction (AOR,1.51). Although free flap breast reconstruction was associate with a higher VTE rate compared with pedicled flap reconstruction (1.2% vs. 0.8%); however, multivariate regressing analysis did not show this factor as an independent VTE risk factor.

Being proactive to make the patients ready to discharge by POD-4 and having strategy to shorten the length of operation could help to lower the rate of VTE in ABR. Plastic surgeons should consider these factors and use appropriate prophylactic measures to minimize the risk of VTE development.