Intraoperative vasopressors and thrombotic complications in free flap breast reconstruction

Autor:	Jonas A. Nelson, Joseph M. Serletti, Ritwik Grover, John P. Fischer, Priscilla Nelson, Alexander Au, Liza C. Wu
Rok vydání:	2017
Předmět:	Adult Graft Rejection endocrine system Fluid administration medicine.medical_specialty Databases Factual Mammaplasty Free flap breast reconstruction Breast Neoplasms Free flap 030230 surgery Free Tissue Flaps Risk Assessment Cohort Studies 03 medical and health sciences 0302 clinical medicine Postoperative Complications Outcome Assessment Health Care Medicine Humans Vasoconstrictor Agents Intraoperative Complications Mastectomy Retrospective Studies Venous Thrombosis Intraoperative Care business.industry Graft Survival Age Factors Retrospective cohort study Perioperative Middle Aged Prognosis Surgery 030220 oncology & carcinogenesis Anesthesia Cohort Female business Perfusion hormones hormone substitutes and hormone antagonists Thrombotic complication
Zdroj:	Journal of plastic surgery and hand surgery. 51(5)
ISSN:	2000-6764
Popis:	The purpose of this study was to critically examine intraoperative vasopressor usage as it relates to free flap perfusion and its effect on perioperative complications in autologous breast reconstruction.A retrospective cohort study was performed involving all free autologous breast reconstructions at a single institution over a 5 year period. Data collection focused on perioperative care, specifically fluid administration, urine output (UOP), use of vasopressors, and case duration. Outcomes included major intraoperative and postoperative complications. Patients who received intraoperative vasopressors were compared to all patients who did not. The use, type, and timing of the vasopressor agent were assessed with standard statistical analyses and regression modelling.Six hundred and eighty-two patients reconstructed with 1039 flaps were included. Of these, 475 (69.6%) patients received vasopressors. The vasopressor cohort was older (p = 0.001), with higher rates of hypertension (p = 0.02). They had a greater number of hypotensive episodes (2.3 vs 0.8, p 0.0001) and received a greater volume of fluid (4653.0 vs 4291.7 ml, p = 0.004). Examining complications, no increase in intraoperative thrombotic events (arterial or venous) or flap loss was noted with vasopressor administration. A higher rate of minor complications was, however, noted (53.1% vs 43.0%, p = 0.016).This study demonstrates that the use of intraoperative vasopressor agents in the anaesthetic care of free flap breast reconstruction patients is common, but likely does not impact thrombotic events or flap loss. Minor complications may, however, be more common in these patients.
Databáze:	OpenAIRE
Externí odkaz:	https://explore.openaire.eu/search/publication?articleId=doi_dedup___::4d50fa2e054ea707fa17ccf4922076ac https://pubmed.ncbi.nlm.nih.gov/28084138 Zobrazit plný text záznamu Plný text ve formátu PDF Plný text ve formátu HTML
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