title: Predictors and consequences of intraoperative microvascular problems in autologous breast reconstruction.
abstract: BACKGROUND
  Microvascular complications can have devastating consequences in breast reconstruction. Because of the relatively low rate of complications, it can be difficult to identify significant predictors of failure. This study explores the importance of intraoperative microvascular problems in the development of postoperative complications and seeks to identify risk factors that may predict such events.
  
  
  METHODS
  Three hundred and eighty-four patients undergoing 562 microvascular breast reconstructions were eligible for inclusion in this study. Bivariate and multivariate logistic regressions were performed to identify factors showing a significant association with intraoperative microvascular problems and postoperative microvascular complications.
  
  
  RESULTS
  In multivariate logistic regression, intraoperative problems were an independent risk factor for the development of postoperative microvascular complications (odds ratio [OR] 2.7, 95% confidence interval [CI] 1.1-6.6, p = 0.02). Smoking was the only independent predictor of intraoperative events (OR 2.4, 95% CI 1.1-5.3, p = 0.03). While intraoperative problems are predisposed to postoperative microvascular complications in general, those that were thrombotic in nature could be corrected by early recognition and intraoperative revision in the majority of cases.
  
  
  CONCLUSIONS
  This study identifies intraoperative microvascular problems as significant predictors of postoperative complications in breast reconstruction. Smoking increases the rate of intraoperative problems, and although many can be corrected, preoperative smoking cessation may reduce the complexity of microsurgery and optimize postoperative outcomes.
authors: Division of Plastic Surgery and Surgical Oncology, University Health Network and Department of Surgery, University of Toronto, 200 Elizabeth St 8N-867, Toronto, Ontario M5G 2C4, Canada. Electronic address: Anne.O'Neill@uhn.ca.
authors: Anne C
authors: AC
authors: O'Neill
authors: Division of Plastic Surgery and Surgical Oncology, University Health Network and Department of Surgery, University of Toronto, 200 Elizabeth St 8N-867, Toronto, Ontario M5G 2C4, Canada.
authors: Siba
authors: S
authors: Haykal
authors: Division of Plastic Surgery and Surgical Oncology, University Health Network and Department of Surgery, University of Toronto, 200 Elizabeth St 8N-867, Toronto, Ontario M5G 2C4, Canada.
authors: Shaghayegh
authors: S
authors: Bagher
authors: Division of Plastic Surgery and Surgical Oncology, University Health Network and Department of Surgery, University of Toronto, 200 Elizabeth St 8N-867, Toronto, Ontario M5G 2C4, Canada.
authors: Toni
authors: T
authors: Zhong
authors: Division of Plastic Surgery and Surgical Oncology, University Health Network and Department of Surgery, University of Toronto, 200 Elizabeth St 8N-867, Toronto, Ontario M5G 2C4, Canada.
authors: Stefan
authors: S
authors: Hofer
mesh_terms: D000328:Adult; D001940:Breast / Q000098:blood supply*; D002170:Canada; D005260:Female; D058752:Free Tissue Flaps / Q000098:blood supply; D006801:Humans; D007431:Intraoperative Complications / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology / Q000517:prevention & control; D016015:Logistic Models; D016462:Mammaplasty / Q000009:adverse effects / Q000379:methods; D055806:Microvessels / Q000503:physiopathology; D008875:Middle Aged; D016017:Odds Ratio; D010043:Outcome and Process Assessment, Health Care; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology / Q000517:prevention & control; D011379:Prognosis; D012307:Risk Factors; D012907:Smoking / Q000453:epidemiology; D000074606:Smoking Prevention; D013927:Thrombosis / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control
keywords: Breast reconstruction; Free flaps; Intraoperative complications; Microsurgery