Department of Plastic and Reconstructive Surgery, Soonchunhyang University College of Medicine, Seoul, Republic of Korea.
Korean Academic Association of Aesthetic and Reconstructive Breast Surgery, Seoul, Republic of Korea.
Sci Rep. 2022 Mar 29;12(1):5314. doi: 10.1038/s41598-022-09224-7.
Patients undergoing autologous breast reconstruction (ABR) are more likely to require perioperative transfusions due to the increased intraoperative bleeding. In addition to the mastectomy site, further incisions and muscle dissection are performed at the donor sites, including the back or abdomen, increasing the possibility of transfusion. The purpose of this study was to evaluate perioperative transfusion rates and risk factors according to the type of ABR through analysis of big data. Patients who underwent total mastectomy for breast cancer between 2014 and 2019 were identified. The patients were divided into mastectomy only and immediate ABR groups. The transfusion rate was 14-fold higher in the immediate ABR group (16.1%) compared to the mastectomy only group (1.2%). The transfusion rate was highest with the pedicled transverse rectus abdominis myocutaneous flap (24.2%). Performance of the operation in medical institutions located in the provinces and coronary artery disease (CAD) were significant risk factors for the need for transfusion. The perioperative transfusion risk among patients undergoing immediate ABR was related to the flap type, location of medical institution, and CAD. Based on the higher transfusion rate in this study (16.1%) compared to previous studies, the risk factors for the need for transfusion should be determined and evidence-based guidelines should be developed to reduce the transfusion rates.
接受自体乳房重建 (ABR) 的患者由于术中出血增加，更有可能需要围手术期输血。除了乳房切除术部位外，供体部位还需要进一步切开和肌肉解剖，包括背部或腹部，增加了输血的可能性。本研究的目的是通过大数据分析评估根据 ABR 类型的围手术期输血率和危险因素。确定了 2014 年至 2019 年间因乳腺癌接受全乳房切除术的患者。将患者分为单纯乳房切除术组和即刻 ABR 组。即刻 ABR 组的输血率（16.1%）是单纯乳房切除术组（1.2%）的 14 倍。带蒂横行腹直肌肌皮瓣的输血率最高（24.2%）。在省级医疗机构进行手术和冠状动脉疾病（CAD）是需要输血的显著危险因素。即刻 ABR 患者围手术期输血风险与皮瓣类型、医疗机构位置和 CAD 有关。与以往研究相比，本研究的输血率（16.1%）较高，因此应确定输血需求的危险因素，并制定基于证据的指南，以降低输血率。
