27. Hold the Aspirin—Acetylsalicylic Acid is Not Associated With Decreased Flap Failure Risk in Autologous Breast Reconstruction

PURPOSE: Using a large database, this study examined the impact of postoperative acetylsalicylic acid (ASA) use on autologous breast reconstruction complication rates. METHODS: This study queried TriNetX, an electronic health database, in October 2024 for patients with breast cancer who had undergone autologous breast reconstruction. Patients were stratified into two groups; those who received ASA postoperatively and those who had not. Patients were propensity score matched for demographic information and comorbidities, including anticoagulant use. Complication rates were examined at post-operative days 1, 30 and 60. RESULTS: TriNetX query and 1:1 propensity score matching revealed outcomes for 2,694 patients. Flap failure risk was similar between ASA users and non-users at POD1 (14 vs. 10, p = 0.414), POD30 (17 vs. 13, p = 0.460) and POD60 (25 vs. 16, p=0.155). DVT, vascular complication, hematoma, and mortality rates were also similar between groups at all timepoints. ASA users were more likely to experience post-operative wound complications at POD30 and 60, but not POD1. ASA users had a significantly higher risk of transfusion and a lower mean hemoglobin than non-users at all timepoints. CONCLUSION: ASA use postoperatively was not associated with a decreased risk of flap failure in autologous breast reconstruction patients. This study casts doubt upon the utility of postoperative ASA use for thromboprophylaxis and warrants further investigation.