Kingston, Ontario, and Halifax, Nova Scotia, Canada From Queens University; and the Department of Anesthesia and the Division of Plastic and Reconstructive Surgery, Department of Surgery, Dalhousie University.
Plast Reconstr Surg. 2011 May;127(5):1773-1782. doi: 10.1097/PRS.0b013e31820cf1dd.
As the popularity of deep inferior epigastric perforator (DIEP) flap breast reconstruction grows, there remains little information on the transfusion rate of this more technically challenging procedure. The purpose of this study was to examine the perioperative blood loss and patient characteristics of women undergoing DIEP flap breast reconstruction in an attempt to identify independent risk factors that predict increased blood loss and transfusion requirements.
A retrospective chart review identified 144 patients who underwent DIEP flap breast reconstruction performed at Queen Elizabeth II Health Sciences Center between January of 2002 and July of 2009. Intraoperative blood loss, hemoglobin and hematocrit drop, length of hospital stay, incidence of perioperative blood transfusions, and complications were reviewed. This study assessed the effects of older age, obesity, bilateral reconstruction, immediate reconstruction, tamoxifen treatment, and length of surgery on the incidence of perioperative blood transfusion and complications.
A total of 18.8 percent of patients required perioperative blood transfusions. These patients were older and more obese, underwent more immediate and bilateral reconstructions, and had longer mean operative times and hospital stays. Patients who underwent lengthy bilateral DIEP reconstructions were at increased risk of receiving a perioperative blood transfusion (bilateral: relative risk, 2.4; odds ratio, 4.4; long surgery: relative risk, 3.9; odds ratio, 7.3). Blood transfusion recipients had an increased risk and greater odds of experiencing any postoperative complication (relative risk, 2.3; odds ratio, 3.4).
Bilateral reconstruction and length of surgery were the only factors to significantly increase the risk of perioperative blood transfusion. Patients receiving blood transfusions had an increased risk of experiencing a postoperative complication.
随着深下腹直肌穿支皮瓣（DIEP）乳房再造术的普及，有关该技术更具挑战性的手术的输血率信息仍然很少。本研究的目的是检查接受 DIEP 皮瓣乳房再造术的女性的围手术期失血量和患者特征，试图确定独立的危险因素，这些危险因素可预测失血增加和输血需求。
回顾性图表审查确定了 2002 年 1 月至 2009 年 7 月在伊丽莎白女王二世健康科学中心接受 DIEP 皮瓣乳房再造术的 144 名患者。审查了术中失血量，血红蛋白和血细胞比容下降，住院时间，围手术期输血的发生率以及并发症。本研究评估了年龄较大，肥胖，双侧重建，即刻重建，他莫昔芬治疗以及手术时间长短对围手术期输血和并发症发生率的影响。
总共有 18.8％的患者需要围手术期输血。这些患者年龄较大，肥胖程度更高，进行了更多的即刻和双侧重建，并且手术时间和住院时间更长。接受冗长的双侧 DIEP 重建的患者接受围手术期输血的风险增加（双侧：相对风险，2.4；优势比，4.4；手术时间长：相对风险，3.9；优势比，7.3）。输血接受者发生任何术后并发症的风险更高（相对风险，2.3；优势比，3.4）。
双侧重建和手术时间是唯一显著增加围手术期输血风险的因素。接受输血的患者发生术后并发症的风险增加。
