Microsurgical Breast Reconstruction Clinical Outcomes In The Covid19 Era
Victor Z. Zhu, MD, MHS, Robert P. Duggan, BS, Julie E. Park, MD, Linda G. Phillips, MD.
University of Texas Medical Branch, Galveston, TX, USA.
PURPOSE: COVID19 has led to major disruptions in plastic surgery care. Microsurgical breast reconstruction has arguably been affected the most as the procedure is subject to COVID19 elective surgery bans and often competes for limited intensive care unit beds and nursing staff. Additionally, hypercoagulopathy and vasculitis are known manifestations of COVID19, which can increase risk for microsurgical vessel anastomosis failure. This study seeks to determine if the COVID19 pandemic has led to poorer clinical outcomes in microsurgical breast reconstruction due to limited healthcare resources or complications of COVID19 infection.
METHODS: A retrospective, multi-institutional study was conducted using the TriNetX research database, which includes de-identified patient records from 55 healthcare organizations across the United States. Clinical outcomes from microsurgical breast reconstruction patients who had any history of COVID19 infection and underwent surgery from 3/11/2020 to 7/31/2021 were compared with a historical control of microsurgical breast reconstruction patients who underwent surgery from 3/11/2018 to 7/31/2019.
RESULTS: 1309 patients had a history of COVID19 infection and underwent microsurgical breast reconstruction; 2195 patients were included in the historical control. COVID19 breast reconstruction patients were found to have a higher risk of reoperation within 30 days (OR1.57, p<0.01), vascular complications/flap failure (OR1.52, p=0.02), need for additional vascular procedures (OR1.74, p=0.02), wound dehiscence (OR1.34, p=0.01), and need for revision wound closures (OR2.22, p<0.01). No significant differences were found in venous thromboembolism/pulmonary embolism, infection, and hematoma/seroma between the two groups.
Microsurgical breast reconstruction during COVID19 is at increased risk for complications. Surgeons should proceed with caution with these procedures.
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