Teresa Benacquista

Abdominal Contouring: Can the American Society of Anesthesiologists Classification System Help Determine When to Say No?

Background: The purpose of this study was to determine whether the American Society of Anesthesiologists classification system could be used preoperatively to identify patients at high risk for complications after abdominal contouring. Methods: Using the National Surgical Quality Improvement Program database from 2007 to 2012, patients undergoing abdominal contouring procedures were identified and stratified by American Society of Anesthesiologists class. The primary outcome was any complication within 30 days. Secondary outcomes included minor wound, major surgical, and medical complication. Adjusted odds ratios were calculated using logistic regression. Results: A total of 3637 patients were analyzed; 14.6 percent of patients were class I, 59.1 percent were class II, 23.4 percent were class III, and 2.9 percent were class IV. Overall complication and mortality rates were 12 percent and 0.2 percent, respectively. There was a significant trend of increasing odds of any complication with increasing class (class I, OR, 1.0; class II, OR, 1.5; class III, OR, 2.5; class IV, OR, 5.6; p-trend < 0.001). This trend was seen consistently for minor wound complications, medical complications, and major surgical complications (p = 0.007, p = 0.005, and p = 0.001, respectively). Conclusions: The American Society of Anesthesiologists classification system, which is simple and universally applicable, appears to predict significant complications and can be used to rapidly screen patients before abdominal contouring. Furthermore, the authors’ results can be used to inform patient-physician discussion about the risks incurred when undergoing these procedures based on their individual class. Together with optimization of high-risk patients, patient selection using American Society of Anesthesiologists classification may prevent complications and improve outcomes. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, II.

Abstract 29: Improving Decision Making in Breast Reconstruction Through Use of a Validated Picture Option Grid

METHODS: A retrospective review of 560 patients undergoing outpatient breast plastic surgery procedures was conducted. Patients received 1) no preoperative analgesia (n=333), 2) intraoperative IV acetaminophen (n=78), 3) preoperative oral acetaminophen and gabapentin (n=95), or 4) preoperative oral acetaminophen, gabapentin and celecoxib (n=54). Outcomes included PACU narcotic use, pain scores, PACU length-of-stay, rescue anti-emetic use and 30-day complications.

Risk Factors for Postoperative Venous Thromboembolic Complications after Microsurgical Breast Reconstruction

Background Venous thromboembolism (VTE) is a significant cause of postoperative morbidity and a focus of patient safety initiatives. Despite giving appropriate prophylaxis in accordance with the Caprini risk assessment model, we observed a high incidence of VTE in patients undergoing microsurgical breast reconstruction at our institution. To explore factors contributing to these events, we compared patients undergoing microsurgical breast reconstruction who sustained postoperative VTEs to those who did not. Methods A retrospective review of all patients who underwent microsurgical free flap breast reconstruction at Montefiore Medical Center from January 2009 to January 2016 was conducted. Patients were divided into two cohorts; those sustaining postoperative VTE and those who did not. Patients were compared based on demographics, comorbidities, operative time, estimated intraoperative blood loss, need for transfusion, volume of transfusion, and discharge on postoperative aspirin. Results A total of 133 patients underwent microsurgical breast reconstruction during the study period. Nine patients (6.8%) had postoperative VTE and there was one (0.8%) death. Patients having VTE were more likely to be Hispanic (33.3%, n = 3) in the VTE group versus 8.1% (n = 6) in the control group (p = 0.011), more likely to have an increased mean transfusion volume (455.5 ± 367.8 vs. 139.51 ± 221.7 mL, p = 0.03), and were more likely to be discharged without aspirin (77.8%, n = 7 and 58.1%, n = 72; p = 0.003). Conclusion Patients sustaining postoperative VTE after microsurgical breast reconstruction are more likely to have an increased volume of blood transfusions and lack of discharge on postoperative aspirin.

Abstract: The Impact of Implementing a Standardized Postoperative Pathway on Underserved Patients Undergoing Microsurgical Breast Reconstruction

PURPOSE: There is paucity of knowledge regarding the impact of variation in postoperative care for microsurgical breast reconstruction patients. Currently, both optimizing patient outcomes and decreasing the cost of healthcare are of prime concern. Caring for underserved populations presents greater challenges in this realm for many reasons. Our aim was to understand the impact of initiating a standardized postoperative pathway for underserved patients undergoing microsurgical reconstruction.