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A Meta-Analysis of Vasopressor Utilization and Association with Rate of Complications in Microsurgical Reconstruction
Rebecca Knackstedt MD PhD, James Gatherwright MD, Raffi Gurunluoglu MD PhD
Cleveland Clinic
2018-02-12
Presenter: Rebecca Knackstedt
Affidavit:
I agree
Director Name: Steven Bernard
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: General Reconstruction
Introduction
There has been a hesitancy to utilize vasopressors in microsurgical reconstruction. The goal of this study was to perform a meta-analysis examining vasopressor usage and complications in microsurgical reconstruction.
Materials and Methods
A meta-analysis was conducted for articles discussing the vasopressors in microsurgical reconstruction. The primary endpoint was total flap failure. Odds ratios were calculated for each complication and for each study.
Results
Four prospective and six retrospective studies were analyzed yielding 6321 patients and 7526 flaps. 80.8% (6080/7526) of flaps received vasopressors. There were 100 failures in the vasopressor group (15.9%) and 39 in the non-vasopressor group (26.8%) (O.R 0.73 (0.502 – 1.062; p = 0.12). There were 177 take-backs in the vasopressor group (29.9%) and 64 in the non-vasopressor group (4.6%) (O.R. 0.65 (0.482 – 0.865; p < 0.05). The O.R. for flap failures in the breast and head/neck cohorts were 0.788 (0.3241 – 1.9159; p =0.76) and 1.2761 (0.3748 – 4.3448; p = 0.77), respectively, with neither significantly increased in flaps receiving vasopressors. Breast flaps receiving vasopressors were significantly less likely to have flap failures compared to the head and neck group (O.R. 0.3073 (0.1254 – 0.7532); p = 0.006).
Conclusion
Our results suggest that vasopressor utilization does not directly result in increased complications. Counter intuitively; flaps that received vasopressors had a statistically lower rate of take-back and failure. The authors hope that this meta-analysis will emphasize the need for studies examining the dosing, type and duration of perioperative vasopressor utilization in microsurgical reconstruction with an emphasis on outcomes.
