title: Intraoperative vasopressors and thrombotic complications in free flap breast reconstruction.
abstract: OBJECTIVE
  The purpose of this study was to critically examine intraoperative vasopressor usage as it relates to free flap perfusion and its effect on perioperative complications in autologous breast reconstruction.
  
  
  METHODS
  A retrospective cohort study was performed involving all free autologous breast reconstructions at a single institution over a 5 year period. Data collection focused on perioperative care, specifically fluid administration, urine output (UOP), use of vasopressors, and case duration. Outcomes included major intraoperative and postoperative complications. Patients who received intraoperative vasopressors were compared to all patients who did not. The use, type, and timing of the vasopressor agent were assessed with standard statistical analyses and regression modelling.
  
  
  RESULTS
  Six hundred and eighty-two patients reconstructed with 1039 flaps were included. Of these, 475 (69.6%) patients received vasopressors. The vasopressor cohort was older (p = 0.001), with higher rates of hypertension (p = 0.02). They had a greater number of hypotensive episodes (2.3 vs 0.8, p < 0.0001) and received a greater volume of fluid (4653.0 vs 4291.7 ml, p = 0.004). Examining complications, no increase in intraoperative thrombotic events (arterial or venous) or flap loss was noted with vasopressor administration. A higher rate of minor complications was, however, noted (53.1% vs 43.0%, p = 0.016).
  
  
  CONCLUSIONS
  This study demonstrates that the use of intraoperative vasopressor agents in the anaesthetic care of free flap breast reconstruction patients is common, but likely does not impact thrombotic events or flap loss. Minor complications may, however, be more common in these patients.
authors.affiliation: a Division of Plastic Surgery , Hospital of the University of Pennsylvania , Philadelphia , PA , USA.
authors.forename: Jonas A
authors.initials: JA
authors.lastname: Nelson
authors.affiliation: a Division of Plastic Surgery , Hospital of the University of Pennsylvania , Philadelphia , PA , USA.
authors.forename: John P
authors.initials: JP
authors.lastname: Fischer
authors.affiliation: a Division of Plastic Surgery , Hospital of the University of Pennsylvania , Philadelphia , PA , USA.|b Department of Plastic Surgery , Cleveland Clinic , Cleveland , OH , USA.
authors.forename: Ritwik
authors.initials: R
authors.lastname: Grover
authors.affiliation: a Division of Plastic Surgery , Hospital of the University of Pennsylvania , Philadelphia , PA , USA.|c Department of Anesthesiology , Lankenau Medical Center , Wynnewood , PA , USA.
authors.forename: Priscilla
authors.initials: P
authors.lastname: Nelson
authors.affiliation: a Division of Plastic Surgery , Hospital of the University of Pennsylvania , Philadelphia , PA , USA.
authors.forename: Alex
authors.initials: A
authors.lastname: Au
authors.affiliation: a Division of Plastic Surgery , Hospital of the University of Pennsylvania , Philadelphia , PA , USA.
authors.forename: Joseph M
authors.initials: JM
authors.lastname: Serletti
authors.affiliation: a Division of Plastic Surgery , Hospital of the University of Pennsylvania , Philadelphia , PA , USA.
authors.forename: Liza C
authors.initials: LC
authors.lastname: Wu
mesh_terms: D000328:Adult; D000367:Age Factors; D001943:Breast Neoplasms / Q000473:pathology / Q000601:surgery*; D015331:Cohort Studies; D016208:Databases, Factual; D005260:Female; D058752:Free Tissue Flaps / Q000098:blood supply / Q000637:transplantation*; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D007430:Intraoperative Care / Q000379:methods; D007431:Intraoperative Complications / Q000453:epidemiology / Q000517:prevention & control*; D016462:Mammaplasty / Q000379:methods*; D008408:Mastectomy / Q000379:methods; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D014662:Vasoconstrictor Agents / Q000008:administration & dosage*; D020246:Venous Thrombosis / Q000453:epidemiology / Q000517:prevention & control
chemical_list: D014662:Vasoconstrictor Agents
keywords: Free tissue flaps; outcome assessment (healthcare); vasoconstrictor agents