Trends of Autologous Free Flap Breast Reconstruction and Safety During the COVID-19 Pandemic.

Abstract

Autologous free flap breast reconstruction (ABR) is a valuable surgical option for patients following mastectomy. The COVID-19 pandemic has led to a myriad of factors that have affected access to care, hospital logistics, and post-operative outcomes. This study aims to identify differences in patient selection, hospital course and severity, and post-operative outcomes for patients who underwent ABR during and prior to the COVID-19 pandemic. Patients undergoing ABR from the ACS-NSQIP 2019-2020 database were analyzed to compare sociodemographics, hospital course, and outcomes over the first post-operative month. Multivariable logistic regression was used to identify factors predictive of complications based on operative year. 3,770 breast free flaps were stratified into two groups based on the timing of reconstruction (pre-pandemic and pandemic groups). Patients with a diagnosis of disseminated cancer were significantly less likely to undergo ABR during the COVID-19 pandemic. On univariate analysis, there were no significant differences in post-operative complications between the two groups. When controlling for potentially confounding sociodemographic and clinical risk factors, the COVID-19 group was significantly more likely to undergo reoperation compared to the pre-pandemic group (p< 0.05). When comparing outcomes for patients who underwent ABR prior to and during the COVID-19 pandemic, we found a significant increase in the odds of reoperation for those who had ABR during the pandemic. Debridement procedures and exploration for postoperative hemorrhage, thrombosis or infection increased from the pre-pandemic group to the COVID-19 group. Notably, operative times decreased.