Blood loss and transfusion rates in DIEP flap breast reconstruction. Introducing a new predictor

被引:23
作者
Lymperopoulos, Nikolaos S. [1 ]
Sofos, Stratos [1 ]
Constantinides, Joannis [1 ]
Koshy, Ommen [1 ]
Graham, Kenneth [1 ]
机构
[1] Whiston Hosp, Burns & Plast Surg Unit, Liverpool L35 5DR, Merseyside, England
关键词
DIEP; Transfusion; Blood loss; Free flap; Breast reconstruction; DONOR-SITE COMPLICATIONS; ADVANCED AGE; RISK; MANAGEMENT; SURGERY;
D O I
10.1016/j.bjps.2013.07.013
中图分类号
R61 [外科手术学];
学科分类号
摘要
Background: The popularity of the DIEP flap has increased over the last decade. However, there is little information regarding the transfusion rates of this complex procedure. The current study reports the transfusion rates in patients who underwent DIEP flap reconstruction in our unit with an attempt to correlate significant blood loss with potential predictors such as the abdominal flap weight. Methods-material: A retrospective review of 131 patients who underwent DIEP reconstruction was performed. Patients' characteristics, risk factors, incidence of blood transfusions, Hb drop and complications were reviewed. For statistical analysis the two-tailed Student t-test, chi-squared significance test and multiple regression model were used. Results: 12 patients (9.1%) were transfused compared to 80.3% and 18.8% described in the literature. Definite association was found between the presence of a complication and transfusion. No correlation was found between age, obesity, chemotherapy and/or radiotherapy or tamoxifen treatment and blood loss. However, operation duration, complications and weight all found to have significant correlation. On average, every additional hour of surgery adds 0.25 g of Hb drop; the presence of a complication adds 0.45 g of Hb drop, and every extra gram of tissue removed from the abdomen adds an extra 0.001 g of Hb drop. Conclusion: The different transfusion rates published reflect variations in surgical strategies, different operative technical details but mostly transfusion protocols applied in each unit. As a correlation with complications was found, it is quite important to identify predictors for significant blood loss to optimise the operation outcome which in our study are additional time of surgery, the presence of complication and increased flap weight. (c) 2013 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.
引用
收藏
页码:1659 / 1664
页数:6
相关论文
共 20 条
[1]   Blood transfusion requirements in elective breast reconstruction surgery [J].
Al-Benna, Sammy ;
Rajgarhia, Prachi .
BREAST, 2010, 19 (06) :475-478
[2]   Risk Factors Influencing Transfusion Rates in DIEP Flap Breast Reconstruction [J].
Appleton, Sarah E. ;
Ngan, Adrienne ;
Kent, Blaine ;
Morris, Steven F. .
PLASTIC AND RECONSTRUCTIVE SURGERY, 2011, 127 (05) :1773-1782
[3]   Perioperative fluid overload increases anastomosis thrombosis in the free TRAM flap used for breast reconstruction [J].
Booi D.I. .
European Journal of Plastic Surgery, 2011, 34 (2) :81-86
[4]   Effect of obesity on flap and donor-site complications in free transverse rectus abdominis myocutaneous flap breast reconstruction [J].
Chang, DW ;
Wang, BG ;
Robb, GL ;
Reece, GP ;
Miller, MJ ;
Evans, GRD ;
Langstein, HN ;
Kroll, SS .
PLASTIC AND RECONSTRUCTIVE SURGERY, 2000, 105 (05) :1640-1648
[5]   Assessment of Advanced Age as a Risk Factor in Microvascular Breast Reconstruction [J].
Chang, Eric I. ;
Vaca, Luis ;
DaLio, Andrew L. ;
Festekjian, Jaco H. ;
Crisera, Christopher A. .
ANNALS OF PLASTIC SURGERY, 2011, 67 (03) :255-259
[6]   Factors affecting post-operative complications following skin sparing mastectomy with immediate breast reconstruction [J].
Davies, Kerry ;
Allan, Lyra ;
Roblin, Paul ;
Ross, David ;
Farhadi, Jian .
BREAST, 2011, 20 (01) :21-25
[7]   Perioperative Hemodynamics in Free Flap Breast Reconstruction Incidence, Predictors, and Management of Tachycardia [J].
Fischer, John P. ;
Nelson, Jonas A. ;
Mirzabeigi, Michael N. ;
Serletti, Joseph M. ;
Kanchwala, Suhail .
ANNALS OF PLASTIC SURGERY, 2012, 69 (04) :356-360
[8]   Closer to an Understanding of Fate: The Role of Vascular Complications in Free Flap Breast Reconstruction [J].
Fosnot, Joshua ;
Jandali, Shareef ;
Low, David W. ;
Kovach, Stephen J., III ;
Wu, Liza C. ;
Serletti, Joseph M. .
PLASTIC AND RECONSTRUCTIVE SURGERY, 2011, 128 (04) :835-843
[9]   Do pre-operative abdominal exercises prevent post-operative donor site complications for women undergoing DIEP flap breast reconstruction? A two-centre, prospective randomised controlled trial [J].
Futter, CM ;
Weiler-Mithoff, E ;
Hagen, S ;
Van de Sijpe, K ;
Coorevits, PL ;
Litherland, JC ;
Webster, MHC ;
Hamdi, M ;
Blondeel, PN .
BRITISH JOURNAL OF PLASTIC SURGERY, 2003, 56 (07) :674-683
[10]   ANESTHESIA FOR FREE VASCULARIZED TISSUE TRANSFER [J].
Hagau, Natalia ;
Longrois, Dan .
MICROSURGERY, 2009, 29 (02) :161-167