Indications for blood transfusion following breast reconstruction

Background: Breast reconstruction following mastectomy for breast cancer can be a life-enhancing procedure for the many women who choose to undergo this. Blood transfusion rates following breast reconstruction have been reported as 2.8 % to 95 % with quoted rates of acute transfusion reaction in current literature that range from 0.082 % to 3 %. The aim of this study is to identify the triggers for the transfusion and to understand the effects of haemodilution. Methods: This is a retrospective case note review of all patients who underwent breast reconstruction over a 5-year period. Data were collected on 30 physiological parameters which affect volume status and were analysed using SPSS for windows, chi-squared, independent t test and regression analysis to determine those factors which accurately predict patients who require a post-operative blood transfusion. Results: The study included 139 patients of which 41 patients (29 %) received packed red cells. We used independent t and chi-squared test to identify 10 of the 30 factors as being statistically significant in predicting transfusion. Using a logistic regression analysis model based on these 10 factors, variables that significantly predict blood transfusion were intra-operative blood loss (p = 0.002), pre-operative haemoglobin (p = 0.037) and drain output on day 1 post-op (p = 0.001). When plotted on a ROC curve, the predicted probability lies at 0.74. Conclusion: We conclude that these three factors should be used in deciding the post-operative transfusion of a patient who has undergone breast reconstruction, whilst haemoglobin and haematocrit values are less reliable indicators of transfusion requirements. Level of Evidence : Level III, prognostic study