D32. National Trends in Autologous Breast Reconstruction with Free Tissue Transfer

PURPOSE: Autologous breast reconstruction (ABR) with free tissue transfer has notably evolved in recent years, particularly in surgical efficiency and advanced recovery protocols. This study evaluates whether such trends are reflected on a national level. METHODS: ABR patients from the 2011-2022 NSQIP database were stratified by year of operation into 3-year cohorts. Outcomes included operative time, length of stay (LOS), and 30-day complications. Multivariable logistic regression analyses were performed. RESULTS: 17,515 patients were identified; the most remote (2011-2013) and most recent (2020-2022) cohorts were directly compared. Mean operative time decreased from 8.1 to 7.6 hours, and LOS decreased from 4.8 to 3.4 days (p < 0.001). Significantly fewer patients required transfusion in the later cohort (7.6%) compared to the early cohort (12.1%). Venous thromboembolism rates did not significantly vary between years (0.8%-1.5%). Surgical site infection (SSI) incidence increased from 5.1% to 9.5% (p < 0.001). Statistical analysis demonstrated lower odds of reoperation (OR: 0.82, p = 0.016) and readmission (OR: 0.73, p = 0.003) in 2020-2022 compared to 2011-2013, whereas risk of SSI increased (OR: 1.94, p < 0.001). CONCLUSION: ABR outcomes over the past decade demonstrate significant reductions in length of hospitalization, need for transfusions, and likelihood of reoperation. The notable increase in SSI warrants further investigation into contributing factors. It is important that patient education and counseling regarding microsurgical breast reconstruction reflect the current state of outcomes rather than prior, potentially outdated conceptions.