Predictors and consequences of intraoperative microvascular problems in autologous breast reconstruction.

Abstract

Microvascular complications can have devastating consequences in breast reconstruction. Because of the relatively low rate of complications, it can be difficult to identify significant predictors of failure. This study explores the importance of intraoperative microvascular problems in the development of postoperative complications and seeks to identify risk factors that may predict such events. Three hundred and eighty-four patients undergoing 562 microvascular breast reconstructions were eligible for inclusion in this study. Bivariate and multivariate logistic regressions were performed to identify factors showing a significant association with intraoperative microvascular problems and postoperative microvascular complications. In multivariate logistic regression, intraoperative problems were an independent risk factor for the development of postoperative microvascular complications (odds ratio [OR] 2.7, 95% confidence interval [CI] 1.1-6.6, p = 0.02). Smoking was the only independent predictor of intraoperative events (OR 2.4, 95% CI 1.1-5.3, p = 0.03). While intraoperative problems are predisposed to postoperative microvascular complications in general, those that were thrombotic in nature could be corrected by early recognition and intraoperative revision in the majority of cases. This study identifies intraoperative microvascular problems as significant predictors of postoperative complications in breast reconstruction. Smoking increases the rate of intraoperative problems, and although many can be corrected, preoperative smoking cessation may reduce the complexity of microsurgery and optimize postoperative outcomes.