Extended Vs Standard Duration Venous Thromboembolism Chemoprophylaxis Following Microsurgical Breast Reconstruction: A Retrospective Cohort Study Of Venous Thromboembolism Events
Elliot Le, MD, MBA1, Jessica Saifee, BA2, Ryan Constantine, MD1, Krystle Tuaņo, MD1, Jerry Yang, BS2, Christodoulos Kaoutzanis, MD1, David Mathes, MD3, Matthew Iorio, MD1.
1University of Colorado Anschutz Medical Campus, Aurora, CO, USA, 2University of Colorado School of Medicine, Aurora, CO, USA, 3University of Colorado Anschutz Medical Campus, Denver, CO, USA.
PURPOSE: Microsurgical breast reconstruction following mastectomy represents a high-risk patient group for venous thromboembolism (VTE), but there is limited consensus on postoperative prophylaxis. The aim of this study was to identify the risk of VTE after microsurgical breast reconstruction, the risk reduction associated with postoperative outpatient VTE prophylaxis, and the clinical factors associated with VTE events.
METHODS: A commercially available database of 53 million unique patients, PearlDiver, was used to identify patients with breast cancer that underwent microsurgical breast reconstruction. Patients were grouped into those receiving any form of outpatient VTE prophylaxis at discharge and those who did not. Probability of VTE within 90 days was calculated for each group followed by absolute risk reduction and number needed to treat. A logistic regression, assuming binomial distribution, was performed to determine clinical factors associated with VTE events after surgery.
RESULTS: A total of 22,606 patients underwent microsurgical breast reconstruction from 2010 and 2020. Of these patients, 326 (1.44%) were discharged with VTE prophylaxis and 22,280 (98.56%) were discharged without. No patients developed a VTE in the prophylaxis group, and 403 (1.81%) developed a VTE in the group without prophylaxis. Number needed to prevent one VTE was 55.25 patients. A majority of VTE events occurred after post-operative day (POD) 10 (71.3%). History of VTE had the highest odds ratio (OR = 101.12) in predicting VTE within the 90-day post-operative period followed by immediate reconstruction (OR = 2.28) and history of coagulopathy (OR = 1.96).CONCLUSION: The majority of patients are not given outpatient chemoprophylaxis following microsurgical breast reconstruction. However, as most (>70%) of VTE events occur following discharge, outpatient VTE prophylaxis following microsurgical breast reconstruction should be considered routine.
| Characteristic | Outpatient VTE Prophylaxis (n = 356) | No Outpatient VTE prophylaxis (n = 22,250) | P-value |
| Post-operative VTE | 0 | 403 | 0.0035 |
| Mean Age | 56.99 + 11.6 | 53.54 + 10.3 | <0.00001 |
| Obesity (BMI > 25 kg/m2) | 121 | 5588 | 0.0002 |
| Diabetes mellitus | 81 | 4531 | 0.260 |
| Tobacco use | 75 | 4527 | 0.377 |
| History of VTE | 46 | 536 | <0.00001 |
| History of coagulopathy | 57 | 1090 | <0.00001 |
| Immediate reconstruction | 93 | 5200 | 0.231 |
| Predictor | OR | 2.5% CI | 97.5% CI |
| Age | 1.00 | 0.99 | 1.01 |
| BMI > 25 kg/m2 | 1.33 | 1.05 | 1.69 |
| Diabetes mellitus | 1.34 | 1.05 | 1.73 |
| Tobacco use | 0.91 | 0.70 | 1.19 |
| History of VTE | 101.12 | 79.21 | 129.08 |
| History of coagulopathy | 1.96 | 1.47 | 2.61 |
| Immediate. reonstruction | 2.28 | 1.77 | 2.93 |
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