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Intravenous Fluid Infusion Rate in Microsurgical Breast Reconstruction: Important Lessons Learned from 354 Free Flaps

Zhong, Toni M.D.; Neinstein, Ryan M.D.; Massey, Christine M.Sc.; McCluskey, Stuart A. M.D., Ph.D.; Lipa, Joan M.D., M.Sc.; Neligan, Peter M.B., B.Ch.; Hofer, Stefan O. P. M.D., Ph.D.

Plastic and Reconstructive Surgery: December 2011 - Volume 128 - Issue 6 - p 1153–1160
doi: 10.1097/PRS.0b013e318221da56
Breast: Original Articles
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Background: The purpose of this study was to determine the role of intravenous fluid infusion rate in the development of in-hospital complications in patients undergoing microsurgical breast reconstruction for breast cancer.

Methods: A retrospective review was performed between 2002 and 2009 at a single institution for all consecutive patients undergoing free flap reconstruction of the breast. The authors examined patient variables (age; body mass index; preoperative hemoglobin, hematocrit, and creatinine levels; American Society of Anesthesiologists classification; and cardiac risk factors), surgical variables (type of reconstruction, timing, laterality, need for blood transfusion, and duration of general anesthesia), and fluid variables (rate of crystalloid and colloid infusion in the first 24 hours standardized by weight). The primary outcome was in-hospital complications. The impact of each factor was first determined using univariate tests. The final multivariate logistic regression model was compiled based on variables found to be significant from the univariate analysis and variables felt a priori to affect complication rates.

Results: Of the 260 patients who had a total of 354 free flaps for breast reconstruction, 54 (20.8 percent) had postoperative complications. There were 40 surgical complications (15.4 percent) and 11 medical complications (4.2 percent), and three patients (1.2 percent) had both types. Most complications were flap related (7.3 percent), including two total flap losses (0.8 percent). Multivariate analysis suggested that the extremes of crystalloid infusion rate significantly predicted postoperative complications (p = 0.03) after adjusting for the effect of other covariates.

Conclusion: This is the first study to report that crystalloid infusion rate, a modifiable variable, is an important predictor of postoperative complications following microsurgical breast reconstruction.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.

Toronto, Ontario, Canada; Los Angeles, Calif.; and Seattle, Wash.

From the Division of Plastic Surgery and Department of Anesthesia, University Health Network, Toronto; Division of Plastic Surgery, University of Toronto; Department of Biostatistics, Princess Margaret Hospital; Division of Plastic and Reconstructive Surgery, University of California at Los Angeles; and Center for Reconstructive Surgery, Department of Surgery, University of Washington.

Received for publication December 23, 2010; accepted March 10, 2011.

Disclosure:The authors have no financial relationships or conflicts of interest to report.

Stefan O. P. Hofer, M.D., Ph.D.; Division of Plastic Surgery, Department of Surgery, University Health Network, 200 Elizabeth Street, 8N-865, Toronto, Ontario M5G 2C4, Canada, stefan.hofer@uhn.on.ca

©2011American Society of Plastic Surgeons