by Rochlin, Danielle H.; Sheckter, Clifford C.; Pannucci,
Christopher; Momeni, Arash
Plastic and
Reconstructive Surgery: September
2020 - Volume 146 - Issue 3 - p 465-473
Background:
Venous thromboembolism is a dreaded complication following
microsurgical breast reconstruction. Although the high-risk nature of the
procedure is well known, a thorough analysis of modifiable risk factors has not
been performed. The purpose of this study was to analyze the association of
such factors with the postoperative occurrence of venous thromboembolism
longitudinally.
Methods:
Using the Truven MarketScan Database, a retrospective cohort
study of women who underwent microsurgical breast reconstruction from 2007 to
2015 and who developed postoperative venous thromboembolism within 90 days of
reconstruction was performed. Predictor variables included age, timing of
reconstruction, body mass index, history of radiation therapy, history of venous
thromboembolism, Elixhauser Comorbidity Index, and length of stay. Univariate
analyses were performed, in addition to logistic and zero-inflated Poisson
regressions, to evaluate predictors of venous thromboembolism and changes in
venous thromboembolism over the study period, respectively.
Results:
Twelve thousand seven hundred seventy-eight women were
identified, of which 167 (1.3 percent) developed venous thromboembolism. The
majority of venous thromboembolisms (67.1 percent) occurred following discharge,
with no significant change from 2007 to 2015. Significant predictors of venous
thromboembolism included Elixhauser score (p < 0.01), history of venous
thromboembolism (p < 0.03), and length of stay (p < 0.001). Compared to
patients who developed a venous thromboembolism during the inpatient stay,
patients who developed a postdischarge venous thromboembolism had a lower mean
Elixhauser score (p < 0.001).
Conclusions:
Postoperative venous thromboembolism continues to be an
inadequately addressed problem, as evidenced by a stable incidence over the
study period. Identification of modifiable risk factors, such as length of
stay, provides potential avenues for intervention. As the majority of venous
thromboembolisms occur following discharge, future studies are warranted to
investigate the role for an intervention in this period. CLINICAL
QUESTION/LEVEL OF EVIDENCE: Risk, III.
