Blood transfusion tied to higher complication risk after autologous breast reconstruction

Blood transfusion occurs with a striking frequency among autologous breast reconstruction patients and is associated with an increased risk of surgery-related complications, a recent study has found.

The study included 55,840 patients (mean age, 52±10 years) who had undergone autologous breast reconstruction surgery from 2012 to 2014 in the United States. The primary study outcomes were the overall rate of blood transfusion and the associated risk factors and outcomes.

Seven percent of all participants required blood transfusion. This rate was lowest in those who underwent latissimus dorsi myocutaneous flap procedures (3.3 percent) and highest in the free gluteal artery perforator flap patients (22 percent).

Patients who underwent blood transfusion also suffered from complications much more frequently (29.55 percent vs 8.48 percent; p<0.01) and stayed in the hospital for a significantly longer duration (6.6 vs 3.6 days; p<0.01). Death was also more common in these patients (0.51 percent vs 0.02 percent; p<0.01).

All other complications, such as urinary tract infection, acute respiratory failure, wound infections and dehiscence, flap failure, myocardial infarction, stroke, and pneumonia, among others, occurred significantly more frequently in those who required blood transfusions. The only exceptions were fat necrosis (p=0.89) and seroma (p=0.17).

Multivariate regression analysis found that chronic anaemia, congestive heart failure, free flap, chronic kidney disease, hypertension, chronic lung disease, diabetes mellitus and obesity were significant risk factors for the need for blood transfusion.