Predicting a Relative Drop in Hematocrit after Abdominally- based Autologous Breast Reconstruction
Charalampos Siotos, MD, Emily Clarke- Pearson, MD, Ricardo J. Bello, MD, MPH, Melanie R. Major, BS, Gurjot Walia, BS, Will W. Wang, BS, Damon S. Cooney, MD, PhD, Michele A. Manahan, MD, Carisa M. Cooney, MPH, Steve Frank, MD, Gedge D. Rosson, MD.
Johns Hopkins University, Baltimore, MD, USA.
BACKGROUND: Free abdominal flap breast reconstruction can lead to a significant drop in hematocrit, attributed to blood loss and the dilutional effect of non-transfusion volume replacement over many operative hours. This study aimed to determine predictors of hematocrit drop in free abdominal flap breast reconstructions and assess its association with patient characteristics and perioperative blood transfusions.
METHODS: We included all patients who underwent free abdominal flap breast reconstruction at Johns Hopkins Hospital between 2009-2015. We obtained perioperative hematocrit levels and blood utilization from prospectively-collected anesthesia and blood management databases. We used t-test and linear regression to determine factors associated with a drop of hematocrit and, ultimately, the need to transfuse.
RESULTS: 653 patients were included. The mean drop in hematocrit was a 19.3% (SD: 13.9%, 95% CI: 18.2-20.3%) decrease from preoperative values. An increased drop in hematocrit was associated with increased estimated blood loss (p=0.043) and operative time (p=0.001), but not with volume of intraoperative crystalloids (p=0.108) or intraoperative colloids (p=0.109) used. Sixty-five patients (10.0%) received blood transfusions. Increased drop in hematocrit was associated with blood transfusions (p<0.001), even after controlling for potential confounders (p<0.001). Patients with preoperative hematocrit under 34% were at higher risk of receiving perioperative blood transfusions (p=0.017). An increased drop in hematocrit was associated with higher risk of postoperative infections (p=0.004) and sepsis (p=0.002).
CONCLUSIONS: In patients undergoing free abdominal flap breast reconstruction, understanding which patients are at greater risk of postoperative transfusion can help minimize transfusions and their well-recognized potential negative effects.
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