Perioperative Venous Thromboembolism Chemoprophylaxis Does Not Increase Risk of Complications in Free Flap Breast Reconstruction Journal Article
| Authors: | Graziano, F. D.; Amakiri, U. O.; Levy, J.; Shammas, R. L.; Rubin, J.; Boe, L.; Matros, E.; Mehrara, B. J.; Allen, R. J.; Nelson, J. A. |
| Article Title: | Perioperative Venous Thromboembolism Chemoprophylaxis Does Not Increase Risk of Complications in Free Flap Breast Reconstruction |
| Abstract: | Background: Patients undergoing abdominal-based free flap breast reconstruction are at risk for perioperative venous thromboembolism (VTE), but the optimal anticoagulation protocol remains unknown. We hypothesized that a standardized chemoprophylaxis protocol would minimize VTE events without increasing hematoma, flap loss, or reoperation. Methods: A retrospective review was conducted on patients who underwent abdominal-based free flap breast reconstruction from 2010 to 2023. In 2015, we implemented an enhanced recovery after surgery (ERAS) protocol including preoperative enoxaparin. Patients with a BMI < 30 and > 30 received enoxaparin for 7 and 30 days postoperatively, respectively. 2010–2015 patients were pre-ERAS and 2015–2023 patients were the ERAS cohort. Patient demographics, comorbidities, and outcomes were analyzed. The primary outcomes were VTE, hematoma, flap loss, and reoperation. Results: 2317 patients were included: 679 were pre-ERAS and 1638 were in the ERAS cohort. The incidence of deep vein thrombosis (0.7%) and pulmonary embolism (pre-ERAS 0.6% vs. ERAS 0.5%) was low in both cohorts with no significant differences. Hematoma (pre-ERAS 7.2% vs. ERAS 5.5%) and reoperation (pre-ERAS 7.8% vs. ERAS 9.7%) were similar, but the ERAS cohort had significantly lower flap failure (0.7% vs. 2.1%, p < 0.05). Conclusions: A standardized perioperative anticoagulation protocol for abdominal-based breast reconstruction maintained low VTE rates without increasing hematoma, flap failure, or reoperation. © 2024 Wiley Periodicals LLC. |
| Keywords: | adult; controlled study; aged; middle aged; retrospective studies; major clinical study; outcome assessment; chemoprophylaxis; incidence; cohort analysis; pathology; breast neoplasms; breast reconstruction; mammaplasty; retrospective study; lung embolism; postoperative complication; postoperative complications; body mass; graft failure; breast tumor; reoperation; comorbidity; anticoagulants; surgery; hospital readmission; epidemiology; free tissue graft; hematoma; enoxaparin; prevention and control; venous thromboembolism; anticoagulant agent; perioperative care; etiology; adverse event; chemoprevention; demographics; free tissue flaps; procedures; humans; human; female; article; enhanced recovery after surgery; abdominal-based free flap; chemoprophylactic anticoagulation |
| Journal Title: | Journal of Surgical Oncology |
| Volume: | 131 |
| Issue: | 6 |
| ISSN: | 0022-4790 |
| Publisher: | Wiley Blackwell |
| Date Published: | 2025-01-01 |
| Start Page: | 1211 |
| End Page: | 1221 |
| Language: | English |
| DOI: | 10.1002/jso.28030 |
| PUBMED: | 39635780 |
| PROVIDER: | scopus |
| DOI/URL: | |
| Notes: | Article -- Source: Scopus |
Altmetric
Citation Impact
BMJ Impact Analytics
Related MSK Work