A UK consensus statement on thromboprophylaxis for autologous breast reconstruction

Microsurgical breast reconstruction accounts for 22% of breast reconstructions in the UK. Despite thromboprophylaxis, venous thromboembolism (VTE) occurs in up to 4% of cases. Using a Delphi process, this study established a UK consensus on VTE prophylaxis strategy, for patients undergoing autologou...

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Veröffentlicht in:	Journal of plastic, reconstructive & aesthetic surgery Jg. 81; S. 138 - 148
Hauptverfasser:	Savage, Jessica A, Hunt, Beverley J., Stansby, Gerard, Dickson, John K., Henton, John M.D., Hunter, Judith, Ramsey, Kelvin, Fung, Victoria, Holt, Rachel, Hussain, Amer, Kalu, Peter, Kotwal, Ashutosh, Majdak-Paredes, Ewa, McGoldrick, Ciara, Morgan, Mary, Nguyen, Dai Q.A., Waters, Ruth, Wilson, Sherif, Mackey, Simon
Format:	Journal Article
Sprache:	Englisch
Veröffentlicht:	Netherlands Elsevier Ltd 01.06.2023
Schlagworte:	Anticoagulants - therapeutic use Breast reconstruction Guidelines Humans Mammaplasty Microsurgery Surveys and Questionnaires Thromboprophylaxis United Kingdom Venous Thromboembolism Venous Thromboembolism - prevention & control United Kingdom Microsurgery Thromboprophylaxis Venous Thromboembolism Breast reconstruction Guidelines
ISSN:	1748-6815, 1878-0539, 1878-0539
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Abstract	Microsurgical breast reconstruction accounts for 22% of breast reconstructions in the UK. Despite thromboprophylaxis, venous thromboembolism (VTE) occurs in up to 4% of cases. Using a Delphi process, this study established a UK consensus on VTE prophylaxis strategy, for patients undergoing autologous breast reconstruction using free-tissue transfer. It captured geographically divergent views, producing a guide that reflected the peer opinion and current evidence base. Consensus was ascertained using a structured Delphi process. A specialist from each of the UK’s 12 regions was invited to the expert panel. Commitment to three to four rounds of questions was sought at enrollment. Surveys were distributed electronically. An initial qualitative free-text survey was distributed to identify likely lines of consensus and dissensus. Each panelist was provided with full-text versions of key papers on the topic. Initial free-text responses were analyzed to develop a set of structured quantitative statements, which were refined via a second survey as a consensus was approached. The panel comprised 18 specialists: plastic surgeons and thrombosis experts from across the UK. Each specialist completed three rounds of surveys. Together, these plastic surgeons reported having performed more than 570 microsurgical breast reconstructions in the UK in 2019. A consensus was reached on 27 statements, detailing the assessment and delivery of VTE prophylaxis. To our knowledge, this is the first study to collate current practice, expert opinion from across the UK, and a literature review. The output was a practical guide for VTE prophylaxis for microsurgical breast reconstruction in any UK microsurgical breast reconstruction unit.
AbstractList	Microsurgical breast reconstruction accounts for 22% of breast reconstructions in the UK. Despite thromboprophylaxis, venous thromboembolism (VTE) occurs in up to 4% of cases. Using a Delphi process, this study established a UK consensus on VTE prophylaxis strategy, for patients undergoing autologous breast reconstruction using free-tissue transfer. It captured geographically divergent views, producing a guide that reflected the peer opinion and current evidence base. Consensus was ascertained using a structured Delphi process. A specialist from each of the UK’s 12 regions was invited to the expert panel. Commitment to three to four rounds of questions was sought at enrollment. Surveys were distributed electronically. An initial qualitative free-text survey was distributed to identify likely lines of consensus and dissensus. Each panelist was provided with full-text versions of key papers on the topic. Initial free-text responses were analyzed to develop a set of structured quantitative statements, which were refined via a second survey as a consensus was approached. The panel comprised 18 specialists: plastic surgeons and thrombosis experts from across the UK. Each specialist completed three rounds of surveys. Together, these plastic surgeons reported having performed more than 570 microsurgical breast reconstructions in the UK in 2019. A consensus was reached on 27 statements, detailing the assessment and delivery of VTE prophylaxis. To our knowledge, this is the first study to collate current practice, expert opinion from across the UK, and a literature review. The output was a practical guide for VTE prophylaxis for microsurgical breast reconstruction in any UK microsurgical breast reconstruction unit. Microsurgical breast reconstruction accounts for 22% of breast reconstructions in the UK. Despite thromboprophylaxis, venous thromboembolism (VTE) occurs in up to 4% of cases. Using a Delphi process, this study established a UK consensus on VTE prophylaxis strategy, for patients undergoing autologous breast reconstruction using free-tissue transfer. It captured geographically divergent views, producing a guide that reflected the peer opinion and current evidence base.Microsurgical breast reconstruction accounts for 22% of breast reconstructions in the UK. Despite thromboprophylaxis, venous thromboembolism (VTE) occurs in up to 4% of cases. Using a Delphi process, this study established a UK consensus on VTE prophylaxis strategy, for patients undergoing autologous breast reconstruction using free-tissue transfer. It captured geographically divergent views, producing a guide that reflected the peer opinion and current evidence base.Consensus was ascertained using a structured Delphi process. A specialist from each of the UK's 12 regions was invited to the expert panel. Commitment to three to four rounds of questions was sought at enrollment. Surveys were distributed electronically. An initial qualitative free-text survey was distributed to identify likely lines of consensus and dissensus. Each panelist was provided with full-text versions of key papers on the topic. Initial free-text responses were analyzed to develop a set of structured quantitative statements, which were refined via a second survey as a consensus was approached.METHODSConsensus was ascertained using a structured Delphi process. A specialist from each of the UK's 12 regions was invited to the expert panel. Commitment to three to four rounds of questions was sought at enrollment. Surveys were distributed electronically. An initial qualitative free-text survey was distributed to identify likely lines of consensus and dissensus. Each panelist was provided with full-text versions of key papers on the topic. Initial free-text responses were analyzed to develop a set of structured quantitative statements, which were refined via a second survey as a consensus was approached.The panel comprised 18 specialists: plastic surgeons and thrombosis experts from across the UK. Each specialist completed three rounds of surveys. Together, these plastic surgeons reported having performed more than 570 microsurgical breast reconstructions in the UK in 2019. A consensus was reached on 27 statements, detailing the assessment and delivery of VTE prophylaxis.RESULTSThe panel comprised 18 specialists: plastic surgeons and thrombosis experts from across the UK. Each specialist completed three rounds of surveys. Together, these plastic surgeons reported having performed more than 570 microsurgical breast reconstructions in the UK in 2019. A consensus was reached on 27 statements, detailing the assessment and delivery of VTE prophylaxis.To our knowledge, this is the first study to collate current practice, expert opinion from across the UK, and a literature review. The output was a practical guide for VTE prophylaxis for microsurgical breast reconstruction in any UK microsurgical breast reconstruction unit.CONCLUSIONTo our knowledge, this is the first study to collate current practice, expert opinion from across the UK, and a literature review. The output was a practical guide for VTE prophylaxis for microsurgical breast reconstruction in any UK microsurgical breast reconstruction unit.
Author	Henton, John M.D. Kotwal, Ashutosh Morgan, Mary Hunt, Beverley J. Dickson, John K. Mackey, Simon McGoldrick, Ciara Savage, Jessica A Holt, Rachel Hussain, Amer Hunter, Judith Nguyen, Dai Q.A. Stansby, Gerard Waters, Ruth Kalu, Peter Majdak-Paredes, Ewa Wilson, Sherif Ramsey, Kelvin Fung, Victoria
Author_xml	– sequence: 1 givenname: Jessica A surname: Savage fullname: Savage, Jessica A email: Jessica.savage1@nhs.net organization: Salisbury District Hospital, England, UK – sequence: 2 givenname: Beverley J. surname: Hunt fullname: Hunt, Beverley J. organization: Thrombosis & Haemostasis, Guy’s and St Thomas’ NHS Foundation Trust, London, England, UK – sequence: 3 givenname: Gerard surname: Stansby fullname: Stansby, Gerard organization: Newcastle University, England, UK – sequence: 4 givenname: John K. surname: Dickson fullname: Dickson, John K. organization: Derriford Hospital, Plymouth, England, UK – sequence: 5 givenname: John M.D. surname: Henton fullname: Henton, John M.D. organization: Department of Burns and Plastic Surgery, Royal Victoria Infirmary, Newcastle upon Tyne, England, UK – sequence: 6 givenname: Judith surname: Hunter fullname: Hunter, Judith organization: Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, England, UK – sequence: 7 givenname: Kelvin surname: Ramsey fullname: Ramsey, Kelvin organization: Royal Marsden NHS Foundation Trust, London, England, UK – sequence: 8 givenname: Victoria surname: Fung fullname: Fung, Victoria organization: Department of Breast and Plastic surgery, Sheffield Teaching Hospitals NHS Trust, England, UK – sequence: 9 givenname: Rachel surname: Holt fullname: Holt, Rachel organization: Wythenshawe Hospital, Manchester and The Alexandra Hospital, Cheadle, England, UK – sequence: 10 givenname: Amer surname: Hussain fullname: Hussain, Amer organization: Department of Plastic Surgery, Leeds, England, UK – sequence: 11 givenname: Peter surname: Kalu fullname: Kalu, Peter organization: Department of Plastic Surgery, Oxford University Hospitals NHS Trust, Oxford, England, UK – sequence: 12 givenname: Ashutosh surname: Kotwal fullname: Kotwal, Ashutosh organization: Hull University Teaching Hospitals NHS Trust, England, UK – sequence: 13 givenname: Ewa surname: Majdak-Paredes fullname: Majdak-Paredes, Ewa organization: Department of Plastic Surgery, Edinburgh Breast Unit, Edinburgh, Scotland, UK – sequence: 14 givenname: Ciara surname: McGoldrick fullname: McGoldrick, Ciara organization: Belfast City Hospital, Northern Ireland, UK – sequence: 15 givenname: Mary surname: Morgan fullname: Morgan, Mary organization: St Andrew’s Centre for Plastic Surgery and Burns, Chelmsford, England, UK – sequence: 16 givenname: Dai Q.A. surname: Nguyen fullname: Nguyen, Dai Q.A. organization: Welsh Centre of Burns and Plastic Surgery, Swansea, Wales, UK – sequence: 17 givenname: Ruth surname: Waters fullname: Waters, Ruth organization: Queen Elizabeth Hospital, Birmingham, England, UK – sequence: 18 givenname: Sherif surname: Wilson fullname: Wilson, Sherif organization: North Bristol NHS Trust, Southmead Hospital, Bristol, England, UK – sequence: 19 givenname: Simon surname: Mackey fullname: Mackey, Simon organization: Department of Plastic and Reconstructive Surgery, Queen Victoria Hospital, East Grinstead, England, UK
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Keywords	Microsurgery Thromboprophylaxis Venous Thromboembolism Breast reconstruction Guidelines
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Snippet	Microsurgical breast reconstruction accounts for 22% of breast reconstructions in the UK. Despite thromboprophylaxis, venous thromboembolism (VTE) occurs in up...
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SubjectTerms	Anticoagulants - therapeutic use Breast reconstruction Guidelines Humans Mammaplasty Microsurgery Surveys and Questionnaires Thromboprophylaxis United Kingdom Venous Thromboembolism Venous Thromboembolism - prevention & control
Title	A UK consensus statement on thromboprophylaxis for autologous breast reconstruction
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