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Venous Thromboembolism in Breast Reconstruction Surgery
Subichin, Michael MD
Patel, Niyant MD
Wagner, Douglas MD
Summa Health System, Northeast Ohio Medical University
2013-02-20
Presenter: Michael Subichin, MD
Affidavit:
I as the resident certify that the vast majority of the abstract represents my original work. This includes conception, design, data collection, and analysis. I further certify that this work has not been presented for any meeting or in any journal.
Director Name: Douglas Wagner MD
Author Category: Other Specialty Resident
Presentation Category: Clinical
Abstract Category: Breast (Aesthetic and Recon.)
Introduction
Venous Thromboembolism (VTE) is a source of significant morbidity and mortality in surgical patients. The incidence of VTE for the various methods of breast reconstruction has not been well described. Over the last decade, models have been developed to determine VTE risk. Recently, the 2005 Caprini risk score has been validated in plastic surgery patients though there is little data for the use of VTE models for specific procedures.
Methods
We performed a retrospective chart review of breast reconstructions by a single surgeon. One hundred consecutive TRAM patients, one hundred consecutive implant patients, and fifty consecutive latissimus dorsi patients were identified. Each chart was analyzed for evidence of VTE. Caprini risk scores were calculated for each patient.
Results
The TRAM reconstruction group had a significantly higher VTE rate (6%) than the implant (0%) and latissimus (0%) reconstruction groups (p=0.00479). TRAM patients stratified as "high risk" for VTE (Caprini score >5) demonstrated a 6.81% (6/88) VTE rate. However, none of the 127 patients in both the Implant and Latissimus groups who were stratified as "high risk" by the Caprini score developed a VTE.
Conclusion
Overall, TRAM reconstruction appears to have a significantly higher risk of VTE than either implant or latissimus reconstruction. While the VTE Caprini risk score had some predictive value in TRAM patients, it was poorly predictive of VTE in both the Implant and Latissimus groups. VTE risk assessment models should take the surgical procedure into account to more accurately determine VTE risk.
