Comparing Flap Monitoring Intervals in the 1st Postoperative Day: A Retrospective Analysis of Major Complications Following Autologous Breast Reconstruction

Abstract

Background: Hourly flap checks are the most common means of assessing the vascular status of flaps during the first 24 hours following autologous breast reconstruction (ABR). This practice often requires ICU admission which is a known driver of healthcare costs and decreased patient satisfaction. This study seeks to address these issues by demonstrating the safety of a longer interval between flap checks during the first 24 hours following ABR. Methods: This is a retrospective review of ABR surgeries performed by multiple surgeons from 2017 to 2020. Two cohorts were present, one which underwent flap checks every hour in the ICU (Q1 cohort) and the other which underwent flap checks every four hours on the hospital floor (Q4 cohort). Our primary outcome measures were length of stay (LOS), flap takebacks, total flap loss, and partial flap loss. Results: 575 total flaps were reviewed. 331 in the Q4 cohort and 244 in the Q1 cohort. There was no significant difference in the rates of flap take back (p=.59), partial flap loss (p=.69) or total flap loss (p=.34) between the two cohorts. The Q4 cohort also had a significantly shorter LOS (p=.01). Conclusion: This study demonstrates the safety of lengthened flap check intervals during the first postoperative day in patients following ABR. Lengthened flap check intervals will decrease the cost of ABR and increase patient satisfaction by avoiding ICU admission. These changes will ultimately make ABR a more accessible means of breast reconstruction for all patients to pursue.