title: Risk factors influencing transfusion rates in DIEP flap breast reconstruction.
abstract: BACKGROUND
  As the popularity of deep inferior epigastric perforator (DIEP) flap breast reconstruction grows, there remains little information on the transfusion rate of this more technically challenging procedure. The purpose of this study was to examine the perioperative blood loss and patient characteristics of women undergoing DIEP flap breast reconstruction in an attempt to identify independent risk factors that predict increased blood loss and transfusion requirements.
  
  
  METHODS
  A retrospective chart review identified 144 patients who underwent DIEP flap breast reconstruction performed at Queen Elizabeth II Health Sciences Center between January of 2002 and July of 2009. Intraoperative blood loss, hemoglobin and hematocrit drop, length of hospital stay, incidence of perioperative blood transfusions, and complications were reviewed. This study assessed the effects of older age, obesity, bilateral reconstruction, immediate reconstruction, tamoxifen treatment, and length of surgery on the incidence of perioperative blood transfusion and complications.
  
  
  RESULTS
  A total of 18.8 percent of patients required perioperative blood transfusions. These patients were older and more obese, underwent more immediate and bilateral reconstructions, and had longer mean operative times and hospital stays. Patients who underwent lengthy bilateral DIEP reconstructions were at increased risk of receiving a perioperative blood transfusion (bilateral: relative risk, 2.4; odds ratio, 4.4; long surgery: relative risk, 3.9; odds ratio, 7.3). Blood transfusion recipients had an increased risk and greater odds of experiencing any postoperative complication (relative risk, 2.3; odds ratio, 3.4).
  
  
  CONCLUSIONS
  Bilateral reconstruction and length of surgery were the only factors to significantly increase the risk of perioperative blood transfusion. Patients receiving blood transfusions had an increased risk of experiencing a postoperative complication.
authors.affiliation: Kingston, Ontario, and Halifax, Nova Scotia, Canada From Queens University; and the Department of Anesthesia and the Division of Plastic and Reconstructive Surgery, Department of Surgery, Dalhousie University.
authors.forename: Sarah E
authors.initials: SE
authors.lastname: Appleton
authors.forename: Adrienne
authors.initials: A
authors.lastname: Ngan
authors.forename: Blaine
authors.initials: B
authors.lastname: Kent
authors.forename: Steven F
authors.initials: SF
authors.lastname: Morris
mesh_terms: D000328:Adult; D001803:Blood Transfusion / Q000706:statistics & numerical data* / Q000639:trends; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007902:Length of Stay; D016462:Mammaplasty / Q000009:adverse effects* / Q000379:methods; D008875:Middle Aged; D009674:Nova Scotia / Q000453:epidemiology; D019106:Postoperative Hemorrhage / Q000453:epidemiology* / Q000209:etiology / Q000628:therapy; D012189:Retrospective Studies; D012307:Risk Factors; D013524:Surgical Flaps / Q000009:adverse effects*