Intravenous Fluid Infusion Rate in Microsurgical Breast Reconstruction: Important Lessons Learned From 354 Free Flaps 1
Plastic and Reconstructive Surgery, 08/18/2011
Zhong T et al. – This is the first study to report that crystalloid infusion rate, a modifiable variable, is an important predictor of postoperative complications following microsurgical breast reconstruction.Methods
- A retrospective review was performed between 2002 and 2009 at a single institution for all consecutive patients undergoing free flap reconstruction of the breast.
- Patient variables (age, BMI, preoperative hemoglobin, hematocrit, creatinine levels, ASA, and cardiac risk factors); surgical variables (type of reconstruction, timing, laterality, need for blood transfusion, and duration of general anesthetic); and fluid variables (rate of crystalloid and colloid infusion in the first 24 hours standardized by weight) were examined.
- The primary outcome was in-hospital complications.
- The impact of each factor was first determined using univariate tests.
- The final multivariate logistic regression model was compiled based on variables found to be significant from the univariate analysis and variables felt a priori to affect complication rates.
- Of the 260 patients who had a total of 354 free flaps for breast reconstruction, 54 patients (20.8%) had postoperative complications.
- There were 40 surgical (15.4%), 11 (4.2%) medical complications, and 3 patients (1.2%) had both types.
- The majority of complications were flap related (7.3%) including 2 total flap losses (0.8%).
- A multivariate analysis suggested that the extremes of crystalloid infusion rate (ml/kg/24hr) significantly predicted postoperative complications (p = 0.03) after adjusting for the effect of other covariates.