Frequency and Risk Factors Associated with Unplanned Return to the Operating Room within the 30-Days Following Free Flap Breast Reconstruction

Masoomi , Hossein; A. Argame , Alexander

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Frequency and Risk Factors Associated with Unplanned Return to the Operating Room within the 30-Days Following Free Flap Breast Reconstruction

Hossein Masoomi ^*¹

, Alexander A. Argame²

1- 1. Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California , Hossein.Masoomi@kp.org
2- 1. Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California

Abstract: (10 Views)

Background: Unplanned return to the operating room (URO) represents an objective measure of postoperative complications. We aimed to identify the frequency, reasons and risk factors for URO in patients undergoing free flap-based breast reconstruction.
Methods: Using American College of Surgeons National Surgery Quality Improvement Project (ACS-NSQIP) database, we examined the clinical data of patients who underwent free flap breast reconstruction from 2016 to 2020 in the United States. Multivariate regression analysis was used to identify risk factors associated with URO within the 30-day from surgery.
Results: A total of 8,398 patients underwent free flap-based breast reconstruction during the study period. The rate of URO was 11.8%. The majority of URO (54.2%) was occurred within the first two days postoperatively. The four most common reported codes were (17.4%: incision and drainage of hematoma or seroma or fluid collection), (11.3%: revision of reconstructed breast), (7.7%: exploration for postoperative hemorrhage, thrombosis or infection) and (4.4%: incision and drainage, deep abscess or hematoma, soft tissues of neck or thorax). The most common used diagnosis code was (11.0%: post procedure hemorrhage). Multivariate regression analysis showed that operative time longer than > 10 hours [odd’s ratio (OR), 1.76], immediate reconstruction (OR,1.34), chronic steroid use (OR,1.87), smoking (OR,1.40), BMI>35 (OR,1.22) and hypertension (OR, 1.19) were independent risk factor for URO.
Conclusion: The rate of URO within the 30-day following free flap-based breast reconstruction is significant (11.8%). The majority of URO was reported within the first two days postoperatively. Hematoma / hemorrhage is the main indications for the return back to the OR.

Keywords: Unplanned return to operating room, Free flap breast reconstruction, Frequency, Risk factors

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Type of Study: Original Article | Subject: Special