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Intraoperative Fluid Management in Patients Undergoing Free Flap Breast Reconstruction: Relationship between Fluid Type, Volume and Complications
Jessica H. Oh, Danielle C. Marshall, Jessica Asirwatham, Anooj Patel, Brian Gastman
Case Western Reserve University School of Medicine
2018-02-14
Presenter: Jessica H. Oh
Affidavit:
Jessica H. Oh
Director Name: Brian Gastman
Author Category: Medical Student
Presentation Category: Clinical
Abstract Category: Breast (Aesthetic and Recon.)
BACKGROUND: In autologous free flap reconstruction, appropriate fluid resuscitation is paramount to maintaining adequate flap perfusion. Literature demonstrates high volumes of perioperative crystalloids induce a hypercoagulable state correlating with postoperative complications including venous thrombosis, other studies show intraoperative fluid resuscitation with colloids impairs coagulation resulting in an increased postoperative risk of bleeding. This study aimed to delineate the relationship between intraoperative fluid administration and postoperative complications.
METHODS: A retrospective review was conducted of patients who underwent autologous free flap breast reconstruction between 2000-2017. Postoperative complications including flap failure, hematoma, and flap congestion were recorded.
RESULTS: 780 patients met inclusion criteria. Median intraoperative crystalloid and 5% albumin volume was 4800ml and 250ml, respectively. Of patients who received intraoperative colloids, 255 (32.3%) received hydroxyethyl starch and 211 (27.1%) 5% albumin. Flap complications included flap failure (1.9%), postoperative revision (10.6%), venous thrombosis (1.6%), hematoma (5.8%), and congestion (4.7%). Intraoperative crystalloid administration was significantly associated with a decreased rate of postoperative flap complications including revision rate (p = 0.019), venous thrombosis (p < 0.001), and congestion (p < 0.001). Intraoperative colloids administration was significantly associated with an increased intraoperative revision rate (p = 0.002) and postoperative hematoma rate (p = 0.011).
CONCLUSION: This study found that crystalloid use did not predispose patients to edema-related complications. Instead, intraoperative colloids usage was significantly associated with an increased rate of postoperative hematoma and flap congestion. These results suggest that colloids may have an adverse effect on flap survival and should be administered stringently to prevent postoperative complications.
