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Postoperative Administration of Acetylsalicylic Acid Does Not Improve Clinical Outcomes after Microsurgical Breast Reconstruction
Farrah C. Liu, MD; Travis J. Miller, MD; Dominic Henn, MD; Dung Nguyen, MD; Arash Momeni, MD, FACS Division of Plastic & Reconstructive Surgery, Stanford University Medical Center, Stanford, CA

Background: Despite significant improvements in microsurgical technique, microvascular thrombosis with resultant flap loss remains a devastating complication. Although microsurgical reconstruction is considered the gold standard reconstructive modality following mastectomy, there are currently no evidence-based guidelines on the prevention of anastomotic thrombosis. While many surgeons administer platelet inhibitors, notably acetylsalicylic acid (ASA), postoperatively, clinical evidence supporting this practice is not robust. The aim of our study was to investigate the impact of postoperative ASA administration on clinical outcomes following microsurgical breast reconstruction.

Methods: A prospectively maintained database of two surgeons (A.M. and D.N.) was queried to identify patients who had undergone microsurgical breast reconstruction. Patients were categorized based on whether they had received postoperative ASA for 30 days (Group 1) vs. had not received ASA (Group 2). Patient demographics were collected, as well as free-flap reconstructive outcomes, complications, and transfusion requirements.

Results: 136 patients with a mean age of 49.5 years and a mean BMI of 28.5 kg/m2 who had undergone a total of 237 microsurgical breast reconstructions were included. No significant differences were noted in regards to patient demographics with the exception of more patients in Group 1 having undergone neoadjuvant chemotherapy and delayed reconstruction (Table 1). There were no significant differences in the rates of postoperative complications including takebacks (p = 1), breast hematoma (p = 1), seroma (p = 1), mastectomy skin flap necrosis (p = 0.29), partial flap necrosis (p = 1), and deep venous thrombosis (p = 1) between patients who did or did not receive ASA postoperatively. Similarly, no difference was noted regarding postoperative blood transfusion rates (Group 1: 12% vs. Group 2: 9%; p=0.78). Finally, patients in Group 1 had significantly longer hospital stay (p=0.0003).

Conclusion: Postoperative ASA administration is not associated with improved postoperative clinical outcomes. Hence, contemporary data do not support this common practice at many microsurgical centers.

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