title: Pulmonary embolism after abdominal flap breast reconstruction: prediction and prevention.
abstract: BACKGROUND
  Symptomatic pulmonary embolism constitutes a significant risk following abdominal flap breast reconstruction. Reported rates vary from 0 to 6 percent. The authors assessed risk factors associated with symptomatic pulmonary embolism and constructed a prediction model to identify high-risk patients.
  
  
  METHODS
  Patients undergoing deep inferior epigastric perforator or transverse rectus abdominis musculocutaneous flap breast reconstructions at two academic centers from January of 2005 through January of 2011 were included. Thromboprophylaxis measures included early ambulation, low-molecular-weight heparin, elastic stockings, A-V Impulse System foot pumps, and pneumatic stockings. Risk factors for symptomatic pulmonary embolism were analyzed and weights were assigned to these risk factors. Sensitivity and specificity were maximized using receiver operating characteristic curves.
  
  
  RESULTS
  Of 430 consecutive patients, symptomatic pulmonary embolism occurred in 17 cases (4.0 percent). Two independent predictors for symptomatic pulmonary embolism were found, body mass index higher than 25, additionally higher than 28, and the BRCA gene mutation. Operation duration and bilaterality of reconstructions were dependent on the BRCA mutation and both indirect predictors for symptomatic pulmonary embolism. Optimization of sensitivity and specificity resulted in a prediction model. No significant differences in efficacy were found between the different thromboprophylaxis measures.
  
  
  CONCLUSIONS
  The rate of symptomatic pulmonary embolism was 4.0 percent, despite standard thromboprophylaxis. Body mass index and BRCA were significant predictors for symptomatic pulmonary embolism. The authors integrated these factors into a prediction model, which provides a useful tool for identification of high-risk patients. This latter category may benefit from a more aggressive thromboprophylaxis approach.
  
  
  METHODS
  Risk, III.
authors.affiliation: Rotterdam and Maastricht, The Netherlands From the Departments of Plastic and Reconstructive Surgery and Medical Psychology and Psychotherapy, Erasmus MC, University Medical Center Rotterdam; and the Department of Plastic and Reconstructive Surgery, Maastricht University Medical Center.
authors.forename: Morteza
authors.initials: M
authors.lastname: Enajat
authors.forename: Tim H C
authors.initials: THC
authors.lastname: Damen
authors.forename: Astrid
authors.initials: A
authors.lastname: Geenen
authors.forename: Reinier
authors.initials: R
authors.lastname: Timman
authors.forename: Rene R W J
authors.initials: RRWJ
authors.lastname: van der Hulst
authors.forename: Marc A M
authors.initials: MAM
authors.lastname: Mureau
mesh_terms: D000328:Adult; D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use; D019313:BRCA1 Protein; D024682:BRCA2 Protein; D015992:Body Mass Index; D004252:DNA Mutational Analysis; D004434:Early Ambulation; D005260:Female; D006801:Humans; D016462:Mammaplasty; D008875:Middle Aged; D017762:Nadroparin / Q000627:therapeutic use; D011183:Postoperative Complications / Q000209:etiology* / Q000235:genetics / Q000517:prevention & control*; D011655:Pulmonary Embolism / Q000209:etiology* / Q000235:genetics / Q000517:prevention & control*; D012307:Risk Factors; D053828:Stockings, Compression; D013524:Surgical Flaps
chemical_list: D000925:Anticoagulants; D019313:BRCA1 Protein; C492913:BRCA1 protein, human; D024682:BRCA2 Protein; C551750:BRCA2 protein, human; D017762:Nadroparin