Vasopressors improve outcomes in autologous free tissue transfer: A systematic review and meta-analysis.

Humans Plastic Surgery Procedures Retrospective Studies Free Tissue Flaps / transplantation Vasoconstrictor Agents / therapeutic use Postoperative Complications / prevention & control
Flap failure Free flap Free tissue transfer Inotrope Vasopressor

Journal

Journal of plastic, reconstructive & aesthetic surgery : JPRAS
ISSN: 1878-0539
Titre abrégé: J Plast Reconstr Aesthet Surg
Pays: Netherlands
ID NLM: 101264239

Informations de publication

Date de publication:
06 2023
Historique:
received: 17 03 2022
revised: 02 07 2022
accepted: 18 08 2022
medline: 29 5 2023
pubmed: 16 11 2022
entrez: 15 11 2022
Statut: ppublish

Résumé

Vasopressor use in patients undergoing autologous free tissue transfer is generally discouraged by surgeons perioperatively. This stems from concerns about the increased risk of flap failure with their use. The aim of this systematic review was to investigate the evidence and quantify any harm or benefits associated with vasopressor use. A systematic review of the literature was undertaken using OVID Medline to search 13 databases. The search strategy used Boolean operators, text word searches, truncation symbols, and adjacency searching. Terms such as "free flap," "free tissue graft," and "free tissue transfer" were used along with a list of appropriate vasopressors. The primary outcome was free flap failure, on which a meta-analysis was performed. The search initially identified 1029 unique articles, which after title and abstract screening was reduced to 112, of which 15 remained after full-text screening for inclusion in the review and analysis. We analyzed data from 8427 flaps, with 6695 having received a vasopressor. Meta-analysis demonstrated that vasopressor use reduced the relative risk (RR) of free flap failure (RR: 0.70; 95% CI: 0.50-0.97; p = 0.03) but did not affect rates of other adverse events (RR: 0.81; 95% CI: 0.63-1.05; p = 0.11). Vasopressor use appears beneficial for autologous free tissue transfer, with evidence that it reduced the risk of flap failure without impacting the rates of other adverse events. The use of vasopressors should, therefore, be encouraged on a case-by-case basis, depending upon the general physiological needs of the patient.

Sections du résumé

BACKGROUND
Vasopressor use in patients undergoing autologous free tissue transfer is generally discouraged by surgeons perioperatively. This stems from concerns about the increased risk of flap failure with their use. The aim of this systematic review was to investigate the evidence and quantify any harm or benefits associated with vasopressor use.
METHODS
A systematic review of the literature was undertaken using OVID Medline to search 13 databases. The search strategy used Boolean operators, text word searches, truncation symbols, and adjacency searching. Terms such as "free flap," "free tissue graft," and "free tissue transfer" were used along with a list of appropriate vasopressors. The primary outcome was free flap failure, on which a meta-analysis was performed.
RESULT
The search initially identified 1029 unique articles, which after title and abstract screening was reduced to 112, of which 15 remained after full-text screening for inclusion in the review and analysis. We analyzed data from 8427 flaps, with 6695 having received a vasopressor. Meta-analysis demonstrated that vasopressor use reduced the relative risk (RR) of free flap failure (RR: 0.70; 95% CI: 0.50-0.97; p = 0.03) but did not affect rates of other adverse events (RR: 0.81; 95% CI: 0.63-1.05; p = 0.11).
CONCLUSION
Vasopressor use appears beneficial for autologous free tissue transfer, with evidence that it reduced the risk of flap failure without impacting the rates of other adverse events. The use of vasopressors should, therefore, be encouraged on a case-by-case basis, depending upon the general physiological needs of the patient.

Identifiants

DOI: 10.1016/j.bjps.2022.08.069 PMID: 36379854
pubmed: 36379854
pii: S1748-6815(22)00512-5
doi: 10.1016/j.bjps.2022.08.069
pii:
doi:

Substances chimiques

Vasoconstrictor Agents 0

Types de publication

Meta-Analysis Systematic Review Journal Article Review

Langues

eng

Sous-ensembles de citation

IM

Pagination

151-163

Informations de copyright

Copyright © 2022 British Association of Plastic, Reconstructive and Aesthetic Surgeons. All rights reserved.

Déclaration de conflit d'intérêts

Declaration of Competing Interest AHRV has received honorarium from Novartis. Other authors have nothing to disclose.

Auteurs

Omar Noori (O)

School of Medicine, Faculty of Health and Medicine, University of Sydney, Sydney, NSW, Australia.

Jose L Pereira (JL)

School of Medicine, Faculty of Health and Medicine, University of Sydney, Sydney, NSW, Australia.

Despoina Stamou (D)

Department of Anaesthesia, Westmead Hospital, Sydney, NSW, Australia.

Sydney Ch'ng (S)

School of Medicine, Faculty of Health and Medicine, University of Sydney, Sydney, NSW, Australia; Melanoma Institute Australia, North Sydney, NSW, Australia; Department of Plastic Surgery, Royal Prince Alfred Hospital, Sydney, NSW, Australia; Royal Prince Alfred Hospital Institute of Academic Surgery, Sydney Local Health District, Sydney, NSW, Australia.

Alexander Hr Varey (AH)

School of Medicine, Faculty of Health and Medicine, University of Sydney, Sydney, NSW, Australia; Melanoma Institute Australia, North Sydney, NSW, Australia; Department of Plastic Surgery, Westmead Hospital, Sydney, NSW, Australia. Electronic address: alexander.varey@sydney.edu.au.

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Classifications MeSH

questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Vasopressors improve outcomes in autologous...
questionsmedicales.fr › Procédures de chirurgie opératoire › Procédures de chirurgie reconstructive › Vasopressors improve outcomes in autologous...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Caractéristiques des études épidémiologiques › Études épidémiologiques › Études de cohortes › Études rétrospectives › Vasopressors improve outcomes in autologous...
questionsmedicales.fr › Équipement et fournitures › Reconstructions chirurgicales › Lambeaux chirurgicaux › Lambeaux tissulaires libres › Vasopressors improve outcomes in autologous...
questionsmedicales.fr › Actions chimiques et utilisations › Actions pharmacologiques › Utilisations thérapeutiques › Agents cardiovasculaires › Vasoconstricteurs › Vasopressors improve outcomes in autologous...
questionsmedicales.fr › États, signes et symptômes pathologiques › Processus pathologiques › Complications postopératoires › Vasopressors improve outcomes in autologous...