title: Complications Following Abdominal-Based Free Flap Breast Reconstruction: Is a 30 days Complication Rate Representative?
abstract: OBJECTIVE
  The purpose of this study was to analyze timing and frequency of complications following free tissue autologous reconstruction in a single tertiary care institution.
  
  
  METHODS
  From August 2012 to December 2013, all patients operated on for abdominal-based free flap breast reconstruction at a single institution were included. Complications were identified and risk factors associated with them were analyzed using SPSS software.
  
  
  RESULTS
  The total number of patients was 130 with a total of 191 flaps (69 for unilateral and 61 for bilateral reconstructions). Mean surgery time was 570.5 min (±151.24). Fifty-nine of the reconstructed breasts (30.8 %) had early complications. Reoperations due to complications were required in 16 (8.3 %) of the breasts during the first 30 days with seven patients requiring multiple reoperations. Twenty-eight patients required reoperations after 30 days, the most frequent reason being delayed wound healing and abdominal hernia. The most significant complication was a case of disseminated infection with loss of skin coverage of the breasts. Early complications and donor-site complications were higher in active smokers (p = 0.005 and p < 0.001, respectively). Patients with a BMI < 25 had fewer total early complications (p = 0.05), as well as fewer complications on the breast area (p = 0.02). A longer time in the operating room was associated with an increase in late complications (p = 0.018). Bilateral/unilateral operation, immediate/delayed surgery, radiotherapy, age, hypertension, diabetes, and surgery time were not associated with early complications, late complications, or reoperations (p > 0.05).
  
  
  CONCLUSIONS
  Active smoking was found to be a significant risk factor for early complications, reoperations, and donor-site complications. Patients with a normal BMI had fewer early complications, reoperations at 30 days, and complications on the breast area. As a significant number of complications occurred beyond the standard 30-day reporting period, it is important to consider reoperations during an extended period.
  
  
  METHODS
  This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
authors.affiliation: Cleveland Clinic, 9500 Euclid Avenue, A6 Building, Cleveland, OH, 44195, USA, duraese@ccf.org.
authors.forename: Eliana F R
authors.initials: EF
authors.lastname: Duraes
authors.forename: Graham
authors.initials: G
authors.lastname: Schwarz
authors.forename: Paul
authors.initials: P
authors.lastname: Durand
authors.forename: Andrea
authors.initials: A
authors.lastname: Moreira-Gonzalez
authors.forename: Leonardo C
authors.initials: LC
authors.lastname: Duraes
authors.forename: Joao Batista
authors.initials: JB
authors.lastname: de Sousa
authors.forename: Risal S
authors.initials: RS
authors.lastname: Djohan
authors.forename: James
authors.initials: J
authors.lastname: Zins
authors.forename: Steven L
authors.initials: SL
authors.lastname: Bernard
mesh_terms: D000328:Adult; D000368:Aged; D064592:Autografts; D015992:Body Mass Index; D001943:Breast Neoplasms / Q000601:surgery; D015331:Cohort Studies; D019317:Evidence-Based Medicine; D005260:Female; D005500:Follow-Up Studies; D058752:Free Tissue Flaps / Q000098:blood supply / Q000637:transplantation; D006084:Graft Rejection / Q000453:epidemiology*; D006085:Graft Survival; D006801:Humans; D015994:Incidence; D016462:Mammaplasty / Q000009:adverse effects* / Q000379:methods; D008408:Mastectomy / Q000379:methods; D008875:Middle Aged; D064827:Myocutaneous Flap / Q000009:adverse effects* / Q000098:blood supply / Q000637:transplantation*; D011183:Postoperative Complications / Q000453:epidemiology*; D012086:Reoperation / Q000379:methods / Q000706:statistics & numerical data; D012189:Retrospective Studies; D018570:Risk Assessment; D012907:Smoking / Q000009:adverse effects; D013530:Surgical Wound Infection / Q000453:epidemiology / Q000503:physiopathology; D062606:Tertiary Care Centers; D013997:Time Factors