Predictors and consequences of perioperative blood transfusions in deep inferior epigastric perforator flap breast reconstruction.

Abstract

Autologous breast reconstruction with deep inferior epigastric perforator (DIEP) flaps plays a critical role in restoring form and function to the breast after mastectomy. As these operations can involve substantial blood loss, they sometimes require perioperative transfusion. We aimed to identify risk factors for transfusion and associated complications in DIEP flap reconstruction. A retrospective cohort study was conducted of all patients who underwent DIEP flap reconstruction at a single academic institution. Patients were stratified based on perioperative transfusion status. Their demographic, comorbid, and operative variables were compared. Major complications included reoperation and readmission. Other complications included infection, seroma, hematoma, fat necrosis, delayed wound healing, and mastectomy flap necrosis. Between 2015 and 2023, 591 patients met the inclusion criteria; among them, 146 (24.7%) required transfusion. On multivariable analysis, independent predictors of transfusion included bleeding disorders (OR 3.45, p=0.023), diabetes (OR 2.46, p=0.011), bilateral reconstruction (OR 2.08, p=0.015), lower preoperative hemoglobin (OR 0.63, p<0.001), urgent reoperation (OR 5.14, p<0.001), and hematoma (OR 3.73, p<0.001). After adjusting for patient and procedural factors, transfusion was found to be independently associated with donor site dehiscence (OR 1.75, p=0.029). Mastectomy skin flap necrosis was not significant after adjustment (OR 1.36, p=0.417). Bleeding disorders, diabetes, bilateral reconstruction, lower preoperative hemoglobin, urgent reoperation, and hematoma were independently associated with increased transfusion risk. Perioperative transfusions were independently associated with donor site dehiscence. These findings highlight the importance of preoperative optimization and careful intraoperative fluid management, and underscore that blood transfusions, although often necessary, are not without consequences.