A standardized anesthesiology and surgical protocol leads to zero VTE events: A retrospective study in 502 autologous breast reconstructions.

BACKGROUND

Autologous breast reconstruction carries an inherent risk of developing venous thromboembolism (VTE), a complication with potentially severe outcomes. This study evaluated the incidence of VTE events in a large cohort of 502 autologous breast reconstructions, achieved through a standardized surgical, anesthesiologic, and thromboprophylaxis protocol. Our primary aim was to evaluate the effectiveness of this comprehensive approach in preventing VTE events.

METHODS

We conducted a retrospective analysis of 370 patients who underwent autologous breast reconstruction between December 2007 and February 2023, employing a uniform surgical and anesthesiology protocol designed around the enhanced recovery after surgery (ERAS) protocol. The incidence of VTE and flap-related complications was documented, alongside an evaluation of the potential risk factors and Caprini scores.

RESULTS

None of the patients in this cohort developed deep vein thrombosis or pulmonary embolism. Hematomas were noted in 5.4% of the cases. The mean Caprini score observed was 6.67, ranging from 3 to 9. Incidences of total and partial flap necrosis were recorded in 7 (1.4%) and 9 (1.8%) cases, respectively. Analysis revealed no significant disparity in the complication rates between patients categorized as being at low risk (Caprini score ≤6), at 5.4%, and those deemed to have the highest risk and super high risk together (Caprini score ≥7), at 3.8%.

CONCLUSIONS

Our cohort study is the first, to our knowledge, to demonstrate a zero percent incidence of clinical VTE events following autologous breast reconstruction, attributed to the rigorous application of a standardized surgical, anesthesiology, and thromboprophylaxis protocol. This result highlights the potential of a well-implemented pre- and intra-operative management, combined with the ERAS protocol, to significantly reduce the VTE risk in this group of patients.

LEVEL OF EVIDENCE

IV.