Intraoperative Indocyanine Green Angiography Use for Perfusion Assessment in Immediate Breast Reconstruction Is Associated With Reduced Reoperation and Takeback.

[BACKGROUND] Immediate breast reconstruction has higher rates of complications than delayed breast reconstruction, in part due to the risks of mastectomy flap necrosis and adequate flap perfusion in implant-based and autologous reconstruction. This study analyzes the impact of indocyanine green (ICG) on 30-d surgical outcomes among patients who underwent immediate breast reconstruction on a national scale.

[METHODS] A retrospective review was performed using the National Surgical Quality Improvement Program data sets from 2005 to 2022. Multivariable logistic regressions were performed to assess the impact of ICG angiography on surgical outcomes. All regression models demonstrated adequate fit (all P < 0.001).

[RESULTS] Among 11,574,114 patients in the National Surgical Quality Improvement Program database, 11,201 patients underwent immediate breast reconstruction, and 287 (2.6%) of whom underwent intraoperative ICG angiography. ICG angiography was more commonly used in implant-based versus autologous reconstruction (13.7% versus 9.4%, P = 0.035) and in patients with American Society of Anesthesiologists class III or higher (37.3% versus 26.6%, P < 0.001). Multivariable regressions determined that using intraoperative ICG angiography was associated with reduced risk of operation room takebacks by 14.3-fold (odds ratio 0.07 [95% confidence interval 0.01-0.51], P = 0.008) and 30-d reoperation by 4.8-fold (odds ratio 0.21 [95% confidence interval 0.07-0.65], P = 0.007).

[CONCLUSIONS] ICG angiography may be useful in immediate breast reconstruction, especially for patients of higher American Society of Anesthesia class. Surgeons may be more inclined to use this technology to assess mastectomy flap quality in immediate implant-based reconstruction rather than autologous reconstruction.