Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom.
GKT School of Medical Education, King's College London, London, United Kingdom.
J Plast Reconstr Aesthet Surg. 2024 Dec;99:280-288. doi: 10.1016/j.bjps.2024.09.084. Epub 2024 Oct 1.
The objective of this study was to determine the incidence of venous thromboembolism (VTE) following autologous breast reconstruction, assess risk factors that may predict incidence and assess the accuracy of the Caprini risk assessment model.
VTE is a rare, but potentially lethal complication of autologous breast reconstruction. An accurate preoperative risk-stratification strategy is essential to improve patient outcomes by determining the patients who would benefit from extended thromboprophylaxis after surgery.
Patients who underwent autologous free flap breast reconstruction at a London teaching hospital from 2019-2021 were included. Risk factors for VTE were analysed. VTE incidence was assessed, and the risk factors were identified using multivariate analysis.
Overall, 368 patients were included in the study. Among them, 10 (2.72%) had a confirmed diagnosis of post-operative VTE, at an average of 23 days after surgery (range 3-64 days). All VTEs occurred in deep, inferior epigastric artery perforator flap patients with a history of breast cancer. Multivariate regression analysis revealed a statistically significant correlation between the incidence of VTE and Caprini score (p = 0.030) and length of hospital stay (p = 0.007). Tamoxifen use was individually significant for VTE (p = 0.043) but non-significant (p = 0.106) when confounded for length of hospital stay (LOS) and Caprini score.
Current VTE risk assessment tools do not accurately identify patients who are at risk of developing VTE following free flap breast reconstruction. The Caprini risk assessment model and LOS may be useful in predicting post-operative VTE in this cohort. These patients may benefit from extended chemoprophylaxis. Larger prospective studies are required to optimise risk prediction models in this cohort.
本研究旨在确定自体乳房重建后静脉血栓栓塞症（VTE）的发生率，评估可能预测发生率的危险因素，并评估 Caprini 风险评估模型的准确性。
VTE 是自体乳房重建的一种罕见但潜在致命的并发症。准确的术前风险分层策略对于通过确定手术后将从延长抗血栓治疗中受益的患者，改善患者结局至关重要。
纳入 2019 年至 2021 年在伦敦教学医院接受自体游离皮瓣乳房重建的患者。分析 VTE 的危险因素。评估 VTE 的发生率，并使用多变量分析确定危险因素。
共有 368 例患者纳入研究。其中，10 例（2.72%）术后确诊 VTE，平均发生在手术后 23 天（范围 3-64 天）。所有 VTE 均发生在有乳腺癌病史的深部、下腹部动脉穿支皮瓣患者中。多变量回归分析显示，VTE 的发生率与 Caprini 评分（p=0.030）和住院时间（p=0.007）呈显著相关。他莫昔芬的使用与 VTE 有显著相关性（p=0.043），但当与住院时间（LOS）和 Caprini 评分混杂时则无显著相关性（p=0.106）。
目前的 VTE 风险评估工具不能准确识别接受游离皮瓣乳房重建后发生 VTE 的风险患者。Caprini 风险评估模型和 LOS 可能有助于预测该队列患者术后 VTE。这些患者可能受益于延长化学预防。需要更大的前瞻性研究来优化该队列的风险预测模型。
