Is There Increased Incidence Of Acute Deep Venous Thrombosis And Pulmonary Embolism In Trauma Patients Who Undergo Flap Reconstruction?
Darya Kazei, MD, Austin Chen, MD, Samuel Lin, MD, MBA.
Beth Isreal Deaconess Medical Center, Boston, MA, USA.
The incidence of deep venous thrombosis (DVT) in trauma patients varies enormously, and although many risk factors have been identified, there is still a significant morbidity and mortality associated with this e complication. There is limited literature published about the risk of DVT or pulmonary embolism (PE) in trauma patients who undergo flap reconstruction. This study aimed to uncover the incidence of DVT/PE in this population and identify the associated risk factors.
Patients from the National Trauma Data Bank (NTDB) who underwent pedicled or free flap reconstruction after trauma between 2015 and 2016 were analyzed. Patient demographics, comorbidities, and the incidence of DVT and PE were extracted. Logistic regression was performed to adjust for confounders and identify risk factors.
A total of 5413 patients were found to have undergone flap reconstruction after trauma. An incidence of 3.4% (n= 184) for DVT/PE was found, which was significantly higher than that in patients in the NTDB database who did not undergo flap reconstruction (p<0.001). Identified factors associated with DVT/PE included current smoking (Odds Ratio (OR): 0.636, 95% Confidence Interval (CI): 0.415 - 0.975, p=0.037), history of psychiatric disorder (OR: 1.556, 95% CI: 1.010 - 2.396, p=0.043) and drug use disorder (OR: 2.123, 95% CI: 1.440 - 3.130, p = 0.001). Statistically significant independent factors included smoking (β: 0.568; 95% CI: 0.367 - 0.879, p=0.011) and drug use disorder (β: 2.181; 95% CI: 1.460 - 3.260, p<0.001).
Trauma patients who underwent flap reconstruction had a significantly higher risk of deep venous thrombosis or pulmonary embolism compared to patients who did not undergo flap reconstruction. An independent associated risk factor for these complications in the patient population appears to be drug use disorder, which plastic surgeons should may take into account when assessing candidates for flap reconstruction.
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