Abstract

BACKGROUND: Venous thromboembolism (VTE) is a dreaded complication following microsurgical breast reconstruction. While 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 is to analyze the association of such factors with the postoperative occurrence of VTE longitudinally.METHODS: Using the Truven MarketScan Database, a retrospective cohort study of women who underwent microsurgical breast reconstruction from 2007-2015 and who developed postoperative VTE within 90 days of reconstruction was performed. Predictor variables included: age, timing of reconstruction, body mass index, history of radiation, history of VTE, Elixhauser comorbidity score, and length of stay (LOS). Univariate analyses were performed, in addition to logistic and zero-inflated Poisson regressions to evaluate predictors of VTE and changes in VTE over the study period, respectively.RESULTS: 12,778 women were identified, of which 167 (1.3%) developed VTE. The majority of VTEs (67.1%) occurred post-discharge with no significant change from 2007-2015. Significant predictors of VTE included Elixhauser score (p<0.01), history of VTE (p<0.03), and LOS (p<0.001). Compared to patients who developed a VTE during the inpatient stay, patients who developed a post-discharge VTE had a lower mean Elixhauser score (p<0.001).CONCLUSIONS: Postoperative VTE continues to be an inadequately addressed problem as evidenced by a stable incidence over the study period. Identification of modifiable risk factors, such as LOS, provide potential avenues for intervention. As the majority of VTEs occur post-discharge, future studies are warranted to investigate the role for an intervention in this period.

View details for DOI 10.1097/PRS.0000000000007051

View details for PubMedID 32453267