Predictors of blood transfusion in autologous breast reconstruction surgery: A retrospective study using the nationwide inpatient sample database

Abstract

Specific risk factors associated with the use of blood transfusions during and following autologous breast reconstruction are unknown. The purpose of this study was to evaluate the rate of blood transfusion in autologous breast reconstruction and identify independent risk factors of blood transfusion in autologous breast reconstruction. A cohort of patients who had undergone autologous breast reconstruction was identified using the Nationwide Inpatient Sample database from 2012 to 2014 in the United States. Univariate and multivariate regression analyses were performed to identify independent risk factors of blood transfusion in this patient population. A total of 55,840 patients underwent autologous breast reconstruction surgery during this period. The overall rate of blood transfusion was 7.0%. Multivariate regression analysis showed that chronic anemia (adjusted odds ratio [AOR], 5.17), congestive heart failure (AOR, 4.07), free flap (AOR, 2.03), chronic kidney disease (AOR, 1.79), hypertension (AOR, 1.39), chronic lung disease (AOR, 1.23), diabetes mellitus (AOR, 1.21), non-teaching hospital (AOR, 1.20), and obesity (AOR, 1.12) were significant risk factors of blood transfusion. There was no association between age, race, liver disease, smoking, chemotherapy, or reconstruction-time on blood transfusion. Patients who received blood transfusion had a significantly higher overall complication rate, longer length of hospital stay, and higher costs than patients who did not receive blood transfusion. The rate of blood transfusion in autologous breast reconstruction is noticeable (7.0%). Improved awareness of these common risk factors can allow surgeons to identify patients with higher risk to attempt to mitigate complications.