title: The impact of anemia on microsurgical breast reconstruction complications and outcomes.
abstract: BACKGROUND
  Appropriate and adequate blood flow and oxygen delivery to a free flap is paramount to viability and success. We present a comprehensive examination of perioperative anemia, determining its prevalence and effect on complications and outcomes in autologous breast reconstruction.
  
  
  METHODS
  We analyzed all autologous free flap breast reconstruction at the Hospital of the University of Pennsylvania from 2005 to 2011 with regards to anemia (hemoglobin (Hgb) <12 g dL(-1) ). Anemic patients were compared to those with Hgb > 12 g dL(-1) at preoperative and postoperative timepoints. Complications were analyzed relative to HgB levels and the incidence of anemia. Subgroups were analyzed based on worsening degrees of anemia.
  
  
  RESULTS
  Overall, 839 patients were included in the analysis with an 18.3% incidence of preoperative anemia. No significant differences were noted in outcomes of these patients relative to their anemic state, although a higher percent did receive a blood transfusion (18% of anemic patients vs. 6% of nonanemic patients, P < 0.0001). There was a significant incidence of postoperative anemia (93.4%). A subgroup analysis demonstrated that worsening postoperative anemia was significantly related to preoperative HgB (P < 0.0001), bilateral cases (P < 0.0001), immediate reconstructions (P < 0.0001), increased estimated blood loss (P = 0.0001), and higher rates of intraoperative fluid administration (P = 0.025). A higher incidence of medical complications was observed in cohorts with HgB < 10 (P = 0.018).
  
  
  CONCLUSIONS
  Anemia affects a significant portion of breast reconstruction patients. While preoperative anemia is not associated with increased risk of flap related complications, postoperative anemia may be associated with an increased risk of medical complications.
authors.affiliation: Division of Plastic Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA.
authors.forename: Jonas A
authors.initials: JA
authors.lastname: Nelson
authors.forename: John P
authors.initials: JP
authors.lastname: Fischer
authors.forename: Ritwik
authors.initials: R
authors.lastname: Grover
authors.forename: Emily
authors.initials: E
authors.lastname: Cleveland
authors.forename: Jessica
authors.initials: J
authors.lastname: Erdmann-Sager
authors.forename: Joseph M
authors.initials: JM
authors.lastname: Serletti
authors.forename: Liza C
authors.initials: LC
authors.lastname: Wu
mesh_terms: D000740:Anemia / Q000150:complications*; D005260:Female; D006801:Humans; D016462:Mammaplasty / Q000379:methods*; D008866:Microsurgery; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology*; D015995:Prevalence; D012189:Retrospective Studies; D016896:Treatment Outcome