Is microsurgical autologous breast reconstruction safe in patients with a history of venous thromboembolism? A retrospective cohort study of 14,309 patients.

Abstract

Venous thromboembolism (VTE) may suggest underlying hypercoagulable state. As much as thrombotic or thromboembolic events can jeopardize flap surgeries, relatively little is known about the associated postoperative complication risks in microsurgical autologous breast reconstruction (ABR). To investigate postoperative complication risks of microsurgical ABR in patients with a history of VTE, we conducted a retrospective cohort study using TriNetX. Of patients who underwent microsurgical ABR, those with prior VTE comprised the exposure cohort; those without comprised the control cohort. Primary outcomes were postoperative rates of deep vein thrombosis (DVT) and pulmonary embolism (PE). Secondary outcomes were postoperative rates of infection, wound dehiscence, bleeding, pain, emergency department (ED) visits, hospitalizations, and revisions. Outcomes were assessed at postoperative days 30, 60, and 90, except revisions, which were assessed at postoperative year 2. There were 395 and 13,914 patients in the exposure and control cohorts, respectively. At postoperative day 90, patients with prior VTE were at significantly higher risks of postoperative DVT (risk ratio [RR] 16.151, P-value [P] < 0.0001), PE (RR 15.828, P < 0.0001), wound dehiscence (RR 1.354, P = 0.0436), infection (1.697, P = 0.0004), pain (RR 1.667, P < 0.0001), ED visits (RR 2.236, P < 0.0001), and hospitalizations (RR 1.336, P < 0.0001). At postoperative year 2, revision rates were not significantly different. In this unadjusted analysis, patients undergoing microsurgical ABR with a prior history of VTE were at significantly higher risks of postoperative DVT, PE, infection, wound dehiscence, pain, ED visits, and hospitalizations.