An Assessment of Bleeding Complications Necessitating Blood Transfusion across Inpatient Plastic Surgery Procedures: A Nationwide Analysis Using the National Surgical Quality Improvement Program Database.
Adult
Aged
Blood Loss, Surgical
/ statistics & numerical data
Databases, Factual
/ statistics & numerical data
Erythrocyte Transfusion
/ statistics & numerical data
Female
Hospitalization
/ statistics & numerical data
Humans
Male
Mammaplasty
/ adverse effects
Middle Aged
Operative Time
Postoperative Hemorrhage
/ epidemiology
Prevalence
Quality Improvement
/ statistics & numerical data
Plastic Surgery Procedures
/ adverse effects
Retrospective Studies
Journal
Plastic and reconstructive surgery
ISSN: 1529-4242
Titre abrégé: Plast Reconstr Surg
Pays: United States
ID NLM: 1306050
Informations de publication
Date de publication:
05 2019
05 2019
Historique:
entrez:
30
4
2019
pubmed:
30
4
2019
medline:
23
5
2019
Statut:
ppublish
Résumé
This study described the prevalence of bleeding complications necessitating blood transfusion across plastic surgery procedures and identified those procedures that may be associated with higher rates of bleeding. The authors retrospectively identified patients who suffered from postoperative bleeding complications from 2010 to 2015 using the National Surgical Quality Improvement Program database. This is defined by the National Surgical Quality Improvement Program as the need for transfusion of at least one unit of packed or whole red blood cells. Patient characteristics were described using summary statistics, and National Surgical Quality Improvement Program and univariate analysis of patient characteristics and bleeding complications was performed. Overall, 1955 of 95,687 patients experienced bleeding complications. Patients with bleeding complications were more likely to be diagnosed with hypertension, have a longer total operative time, and have a previously diagnosed bleeding disorder. The most common primary plastic surgery procedure associated with bleeding complications was breast reconstruction with a free flap, and breast reconstruction with a pedicled transverse rectus abdominis musculocutaneous flap had the highest rate of bleeding. A return to the operating room was required in 539 patients (27.6 percent) who suffered a postoperative bleeding complication. Patients with a preexisting bleeding disorder [n = 1407 (1.5 percent)] were more likely to be diabetic, have a lower preoperative hematocrit, and have a longer operative time. In addition, these patients were more likely to suffer from other nonbleeding complications (1.29 percent versus 0.35 percent; p < 0.01). Complex procedures (i.e., free flap breast reconstruction) have a higher prevalence of bleeding requiring a transfusion. Furthermore, patients undergoing combined procedures-specifically, breast oncologic and reconstructive cases-may be at a higher risk for experiencing bleeding-related complications. Therapeutic, III.
Sections du résumé
BACKGROUND
This study described the prevalence of bleeding complications necessitating blood transfusion across plastic surgery procedures and identified those procedures that may be associated with higher rates of bleeding.
METHODS
The authors retrospectively identified patients who suffered from postoperative bleeding complications from 2010 to 2015 using the National Surgical Quality Improvement Program database. This is defined by the National Surgical Quality Improvement Program as the need for transfusion of at least one unit of packed or whole red blood cells. Patient characteristics were described using summary statistics, and National Surgical Quality Improvement Program and univariate analysis of patient characteristics and bleeding complications was performed.
RESULTS
Overall, 1955 of 95,687 patients experienced bleeding complications. Patients with bleeding complications were more likely to be diagnosed with hypertension, have a longer total operative time, and have a previously diagnosed bleeding disorder. The most common primary plastic surgery procedure associated with bleeding complications was breast reconstruction with a free flap, and breast reconstruction with a pedicled transverse rectus abdominis musculocutaneous flap had the highest rate of bleeding. A return to the operating room was required in 539 patients (27.6 percent) who suffered a postoperative bleeding complication. Patients with a preexisting bleeding disorder [n = 1407 (1.5 percent)] were more likely to be diabetic, have a lower preoperative hematocrit, and have a longer operative time. In addition, these patients were more likely to suffer from other nonbleeding complications (1.29 percent versus 0.35 percent; p < 0.01).
CONCLUSIONS
Complex procedures (i.e., free flap breast reconstruction) have a higher prevalence of bleeding requiring a transfusion. Furthermore, patients undergoing combined procedures-specifically, breast oncologic and reconstructive cases-may be at a higher risk for experiencing bleeding-related complications.
CLINICAL QUESTION/LEVEL OF EVIDENCE
Therapeutic, III.
Identifiants
pubmed: 31033841
doi: 10.1097/PRS.0000000000005537
pii: 00006534-201905000-00051
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1109e-1117eCommentaires et corrections
Type : CommentIn
Références
Dyke C, Aronson S, Dietrich W, et al. Universal definition of perioperative bleeding in adult cardiac surgery. J Thorac Cardiovasc Surg. 2014;147:1458–1463.e1.
Corral M, Ferko N, Hollmann S, Broder MS, Chang E. Health and economic outcomes associated with uncontrolled surgical bleeding: A retrospective analysis of the Premier Perspectives Database. Clinicoecon Outcomes Res. 2015;7:409–421.
Stokes ME, Ye X, Shah M, et al. Impact of bleeding-related complications and/or blood product transfusions on hospital costs in inpatient surgical patients. BMC Health Serv Res. 2011;11:135.
Glance LG, Dick AW, Mukamel DB, et al. Association between intraoperative blood transfusion and mortality and morbidity in patients undergoing noncardiac surgery. Anesthesiology 2011;114:283–292.
Ferraris VA, Davenport DL, Saha SP, Austin PC, Zwischenberger JB. Surgical outcomes and transfusion of minimal amounts of blood in the operating room. Arch Surg. 2012;147:49–55.
Ferraris VA, Hochstetler M, Martin JT, Mahan A, Saha SP. Blood transfusion and adverse surgical outcomes: The good and the bad. Surgery 2015;158:608–617.
Marietta M, Facchini L, Pedrazzi P, Busani S, Torelli G. Pathophysiology of bleeding in surgery. Transplant Proc. 2006;38:812–814.
Hernandez-Boussard T, McDonald KM, Rhoads KF, Curtin CM. Patient safety in plastic surgery: Identifying areas for quality improvement efforts. Ann Plast Surg. 2015;74:597–602.
Rohrich RJ, Mendez BM, Afrooz PN. An update on the safety and efficacy of outpatient plastic surgery: A review of 26,032 consecutive cases. Plast Reconstr Surg. 2018;141:902–908.
Hynes DM, Weaver F, Morrow M, et al. Breast cancer surgery trends and outcomes: Results from a National Department of Veterans Affairs study. J Am Coll Surg. 2004;198:707–716.
Alderman AK, Wilkins EG, Kim HM, Lowery JC. Complica tions in postmastectomy breast reconstruction: Two-year results of the Michigan Breast Reconstruction Outcome Study. Plast Reconstr Surg. 2002;109:2265–2274.
Collins JB, Verheyden CN. Incidence of breast hematoma after placement of breast prostheses. Plast Reconstr Surg. 2012;129:413e–420e.
Ye X, Lafuma A, Torreton E, Arnaud A. Incidence and costs of bleeding-related complications in French hospitals following surgery for various diagnoses. BMC Health Serv Res. 2013;13:186.
Fröjd V, Jeppsson A. Reexploration for bleeding and its association with mortality after cardiac surgery. Ann Thorac Surg. 2016;102:109–117.
Shander A. Financial and clinical outcomes associated with surgical bleeding complications. Surgery 2007;142(Suppl):S20–S25.
Nwaogu IY, Bommarito K, Olsen MA, Margenthaler JA. Economic impact of bleeding complications after mastectomy. J Surg Res. 2015;199:77–83.
Mehrara BJ, Santoro TD, Arcilla E, Watson JP, Shaw WW, Da Lio AL. Complications after microvascular breast reconstruction: Experience with 1195 flaps. Plast Reconstr Surg. 2006;118:1100–1109; discussion 11101111.
El-Tamer MB, Ward BM, Schifftner T, Neumayer L, Khuri S, Henderson W. Morbidity and mortality following breast cancer surgery in women: National benchmarks for standards of care. Ann Surg. 2007;245:665–671.
Fischer JP, Nelson JA, Sieber B, et al. Transfusions in autologous breast reconstructions: An analysis of risk factors, complications, and cost. Ann Plast Surg. 2014;72:566–571.
Hill JB, Patel A, Del Corral GA, et al. Preoperative anemia predicts thrombosis and free flap failure in microvascular reconstruction. Ann Plast Surg. 2012;69:364–367.
Sarhane KA, Flores JM, Cooney CM, et al. Preoperative anemia and postoperative outcomes in immediate breast reconstructive surgery: A critical analysis of 10,958 patients from the ACS-NSQIP database. Plast Reconstr Surg Glob Open 2013;1:e30.
Thorarinsson A, Fröjd V, Kölby L, et al. A retrospective review of the incidence of various complications in different delayed breast reconstruction methods. J Plast Surg Hand Surg. 2016;50:25–34.
Sullivan SR, Fletcher DR, Isom CD, Isik FF. True incidence of all complications following immediate and delayed breast reconstruction. Plast Reconstr Surg. 2008;122:19–28.
Alderman AK, Collins ED, Streu R, et al. Benchmarking outcomes in plastic surgery: National complication rates for abdominoplasty and breast augmentation. Plast Reconstr Surg. 2009;124:2127–2133.
Parvizi D, Friedl H, Wurzer P, et al. A multiple regression analysis of postoperative complications after body-contouring surgery: A retrospective analysis of 205 patients. Obes Surg. 2015;25:1482–1490.
Pien I, Caccavale S, Cheung MC, et al. Evolving trends in autologous breast reconstruction: Is the deep inferior epigastric artery perforator flap taking over? Ann Plast Surg. 2016;76:489–493.
Leyngold MM. Is unipedicled transverse rectus abdominis myocutaneous flap obsolete owing to superiority of DIEP flap? Ann Plast Surg. 2018;80(Suppl 6):S418–S420.