Incidence and Risk Factors for Venous Thromboembolism in Bilateral Breast Reduction Surgery: An Analysis of the National Surgical Quality Improvement Program

• Published in: Journal of plastic, reconstructive & aesthetic surgery Vol. 70; no. 11; pp. 1514 - 1519
• Main Authors: Rubio, Gustavo A., MD, Zoghbi, Yasmina, MS, Karcutskie, Charles, MD, MA, Thaller, Seth R., MD, DMD, FACS
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Ltd 01.11.2017
• Subjects: Adult; Bilateral breast reduction; Deep venous thrombosis; Female; Follow-Up Studies; Humans; Incidence; Mammaplasty - adverse effects; Middle Aged; NSQIP; Plastic Surgery; Postoperative Complications - epidemiology; Prognosis; Pulmonary embolism; Quality Improvement; Reduction mammaplasty; Retrospective Studies; Risk Assessment - methods; Risk Factors; United States - epidemiology; Venous thromboembolism; Venous Thromboembolism - epidemiology; Venous Thromboembolism - prevention & control; NSQIP; reduction mammaplasty; pulmonary embolism; deep venous thrombosis; bilateral breast reduction; Venous thromboembolism; Pulmonary embolism; Bilateral breast reduction; Reduction mammaplasty; Deep venous thrombosis
• ISSN: 1748-6815; 1878-0539
• DOI: 10.1016/j.bjps.2017.05.050

SUMMARY Background Risk of venous thromboembolism (VTE) in patients undergoing bilateral breast reduction surgery remains unknown. Aim of this study was to determine VTE incidence and risk factors in this patient cohort. Methods American College of Surgeons National Surgical Quality Improvement Program (2010-2014) was used to identify women undergoing bilateral breast reduction. Demographic factors, comorbidities, and rate of postoperative venous thromboembolism (VTE) were evaluated. Bivariate and risk-adjusted multivariate logistic regression were performed to determine factors associated with the development of postoperative VTE. Results A total of 5,371 cases were identified. Mean age was 43.7 years (SD ± 13.9 years). Rate of VTE was 0.22%, with 0.17% rate of pulmonary embolism and 0.07% of deep venous thrombosis requiring treatment. Patients who suffered VTE were older (52.4 ± 12.8 vs. 43.7 ± 13.9 years, p< 0.05), had longer length of stay (1.7 ± 2.9 vs. 0.4 ± 2.1 days, p< 0.05), higher rates of blood transfusion (8.3% vs 0.4%, p< 0.01) and reoperation (16.7% vs. 2.0%, p< 0.01). Risk-adjusted multivariate analysis demonstrated that increasing age (OR 1.05, 95% CI 1.01-1.10), receiving a blood transfusion (OR 13.5, 95% CI 1.3-34.8), and an unplanned return to the operating room (OR 6.7, 95% CI 1.3-112.0) were independent risk factors for developing postoperative VTE. Conclusion In bilateral breast reduction surgery, older patients and those requiring blood transfusion or return to the operating room are at increased risk of developing postoperative VTE. These factors can be considered for patient risk-stratification and perioperative decision-making regarding VTE prevention.