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Outcomes of Free Flap Breast Reconstruction with Vasopressor Use: A Database Driven Propensity Score-Matched Analysis
Olivia Julian
*, Mary Newland, Charles Lee, Rea Chroneos, Timothy S. Johnson, John Roberts
Penn State University, Elysburg, PA
Purpose: Autologous breast reconstruction with free tissue transfer is an integral component of treatment for breast cancer patients. Utilizing agents such as vasopressors for hemodynamic management during free flap surgery remains controversial, as vasoconstriction could decrease tissue perfusion and threaten the viability of the flap. However, the true effects of vasopressor use on free flap outcomes are unknown and existing literature has found mixed results. Therefore, our study aims to analyze the outcomes of free flap breast reconstruction in the setting of perioperative vasopressor use.
Methods: The TriNetX LLC. National Health Research database was utilized to identify breast cancer patients who underwent free flap reconstruction between 2004-2024. The database was further queried for those who did and did not receive vasopressors within 5 days of surgery and the two cohorts were matched for their demographics and comorbidities. Diagnosis and common procedural terminology codes were then used to assess for flap complications including revision of the microvascular anastomosis, flap debridement, hematoma evacuation, sepsis, and venous thromboembolism within 7 days postoperatively.
Results: Of the 17,151 patients who underwent free flap breast reconstruction, a total of 7,309 patients were associated with vasopressor use and 6,842 were not. When the two groups were matched, 5,909 patients were identified in each cohort. There was no significant difference in the rate of free flap complication rates among those who did (16.5%) and did not (17.5%) receive vasopressors perioperatively (p=0.1349).
Conclusion: Our study demonstrates that perioperative vasopressor use does not significantly impact the complication rate associated with free flap breast reconstruction. Patients who received vasopressors did not experience a higher rate of postoperative complications within the first 7 days after the index surgery. Therefore, these results imply that vasopressor use is safe when clinically indicated without an increased risk of complications.
Table 1: Free Flap Breast Reconstruction Complication Rate After Vasopressor Use
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