title: Restrictive use of perioperative blood transfusion does not increase complication rates in microvascular breast reconstruction.
abstract: BACKGROUND
  With increasing appreciation of the possible adverse effects of peri-operative blood transfusion, restrictive policies regarding use of blood products have been adopted in many surgical specialties. Although microvascular breast reconstruction has become a routine procedure, high peri-operative transfusion rates continue to be reported in the literature. In this study we examine the impact of our restrictive approach on blood transfusion rates and postoperative complications in patients undergoing microvascular blood transfusion.
  
  
  METHODS
  A retrospective review of patients undergoing microvascular breast reconstruction with abdominal flaps at a single institution was performed. Patient age and body mass index as well as type, timing and laterality of reconstruction was recorded. Pre-operative and post-operative hemoglobin and hematocrit were recorded. Peri-operative blood transfusion rates were calculated. Post-operative complication rates were compared between patients with higher and lower post-operative hemoglobin levels.
  
  
  RESULTS
  Five hundred and twelve patients were included in this study. The peri-operative transfusion rate was 0.98% in this series. There was no significant difference between transfusion rates in unilateral and bilateral reconstructions (0.68 vs 1.36% p = 0.08) or immediate and delayed reconstructions (1.02 vs 0.51% p = 0.72 and 1.01 vs 1.60% p = 0.09 for unilateral and bilateral respectively). Lower post-operative hemoglobin levels were not associated with increased flap related, surgical or medical complications rates.
  
  
  CONCLUSIONS
  A restrictive approach to peri-operative blood transfusion can be safely adopted in microvascular breast reconstruction without compromising flap viability or overall complication rates.
authors.affiliation: Division of Plastic and Reconstructive Surgery, Department of Surgery and Surgical Oncology, University Health Network, University of Toronto, Toronto, Ontario, Canada. Electronic address: ainenineill@gmail.com.
authors.forename: Anne C
authors.initials: AC
authors.lastname: O'Neill
authors.affiliation: Division of Plastic and Reconstructive Surgery, Department of Surgery and Surgical Oncology, University Health Network, University of Toronto, Toronto, Ontario, Canada; Department of Plastic Surgery, University Hospital of Basel, Basel, Switzerland.
authors.forename: Marina
authors.initials: M
authors.lastname: Barandun
authors.affiliation: Division of Plastic and Reconstructive Surgery, Department of Surgery and Surgical Oncology, University Health Network, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Jieun
authors.initials: J
authors.lastname: Cha
authors.affiliation: Division of Plastic and Reconstructive Surgery, Department of Surgery and Surgical Oncology, University Health Network, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Toni
authors.initials: T
authors.lastname: Zhong
authors.affiliation: Division of Plastic and Reconstructive Surgery, Department of Surgery and Surgical Oncology, University Health Network, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Stefan O P
authors.initials: SO
authors.lastname: Hofer
mesh_terms: D000328:Adult; D000368:Aged; D001803:Blood Transfusion; D001943:Breast Neoplasms / Q000097:blood / Q000601:surgery; D002985:Clinical Protocols; D005260:Female; D006400:Hematocrit; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D007902:Length of Stay; D016462:Mammaplasty; D008833:Microcirculation; D008875:Middle Aged; D019990:Perioperative Care; D011183:Postoperative Complications / Q000097:blood / Q000453:epidemiology*; D012189:Retrospective Studies; D013524:Surgical Flaps
chemical_list: D006454:Hemoglobins
keywords: Breast reconstruction; Microvascular; Preoperative blood transfusion