Factors associated with emergency free flap reoperation in postmastectomy breast reconstruction: A population-based cohort study

BACKGROUND: Reoperation shortly after free flap breast reconstruction is a substantial event with impacts on patients and healthcare utilization. The objective of the study was to evaluate the factors associated with the return to the operating room in free flap breast reconstruction patients. METHODS: This retrospective cohort study included patients who underwent postmastectomy free flap breast reconstruction from 2005 to 2020 in Ontario, Canada. Patient records were identified from a prospectively maintained administrative database stored at the Institute for Clinical Evaluation Sciences. The outcome of interest was emergency return to the operating room within a week of primary autologous breast reconstruction. Univariate and multivariable logistic regression models were used to assess independent factors associated with emergency reoperation. RESULTS: We evaluated 2290 patients who underwent autologous breast reconstruction with free tissue transfer. Overall, 167 patients (7.29%) underwent emergency surgery within 7 days. Most reoperations (86%) occurred within the first 3 days. The odds of reoperation were higher for patients from the lower-income quintiles (quintile 5 vs. quintile 1: adjusted odds ratio [aOR] 2.14, 95% confidence interval [CI] 1.27-3.60, p = 0.004) and in nonteaching hospitals (aOR 1.73, 95% CI 1.09-2.72, p = 0.019). Age, Charlson Comorbidity Index, diabetes, reconstruction timing, geographical location, and rurality were not associated with free flap takeback. CONCLUSION: In a universal health care system, patients from the lowest income quintile and patients who underwent reconstruction at nonteaching hospitals were at increased odds of reoperation. Increased efforts are needed to mitigate the disparities and improve outcomes across all demographics.