Abstract: Perioperative Transfusions and Postoperative Outcomes In Free Flap Reconstructive Surgery: A Critical Analysis Of 6,132 Patients From The ACS-NSQIP Database (Plastic Surgery 2013)

Saturday, October 12, 2013: 2:30 PM

Mark M Melendez, MD, MBA , Plastic and Reconstructive Surgery, Johns Hopkins School of Medicine, Baltimore, MD

Pablo A Baltodano, MD , Plastic and Reconstructive Surgery, Johns Hopkins University, Baltimore, MD

José M Flores, MPH , Epidemiology, Johns Hopkins University, Baltimore, MD

Karim A Sarhane, MD, MSc , Plastic and Reconstructive Surgery, Johns Hopkins University, Baltimore, MD

Francis M Abreu, BSc , Biostatistics, Johns Hopkins University, Baltimore, MD

Carisa M Cooney, MPH , Plastic and Reconstructive Surgery, Johns Hopkins University, Baltimore, MD

Gedge D Rosson, MD , Dept. of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD

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PURPOSE:

Our group previously established that preoperative anemia is independently associated with adverse outcomes in immediate breast reconstructive surgery. However, there remains a paucity of information on the frequency and impact of blood transfusions during free flap reconstruction.^1,2 We aimed to assess the effect of perioperative transfusions on 30-day postoperative morbidity in patients undergoing microvascular free flap reconstructive surgery.

METHODS: Patients who underwent any type of microvascular free flap reconstructive surgery from 2008 to 2011 were identified from the American College of Surgeons National Surgical Quality Improvement Program (a prospective, risk adjusted, outcomes-based registry).³ De-identified data were obtained for 30-day postoperative morbidity, as well as demographics, preoperative and perioperative risk factors. Specific morbidity variables included cardiac, respiratory, neurological, urinary tract, flap, wound and venous thromboembolism outcomes. Logistic regression was used to assess the crude and adjusted effect of perioperative transfusions (defined as a receiving > 1 unit of packed red blood cells within 72 hours before and after the surgery) on postoperative 30-day morbidity.

RESULTS: The study population included 6,132 patients, of whom 608 (15.28 %) received perioperative transfusions. Crude odds ratios predicting 30-day post-operative morbidity were significantly higher in transfused patients than in those not receiving transfusions, OR_unadjusted = 3.89 (p<0.001). This trend prevailed after extensive adjustment for clinically and statistically relevant confounders, yielding a highly significant OR_adjusted = 2.69 (p<0.001) for 30-day morbidity.

CONCLUSION: These results provide strong evidence of an adverse effect of perioperative transfusions on the postoperative outcomes of free flap reconstructive surgery, demonstrating a strong independent association between perioperative transfusions and increased risk of 30-day morbidity.

23026 Perioperative Transfusions and Postoperative Outcomes In Free Flap Reconstructive Surgery: A Critical Analysis Of 6,132 Patients From The ACS-NSQIP Database