Postoperative Tachycardia in Deep Inferior Epigastric Perforator Flap Breast Reconstruction: Is It a Reason to Worry?

[BACKGROUND]  Many patients who undergo free flap breast reconstruction develop postoperative hemodynamic changes, most noticeably, tachycardia. As there is currently no consensus on whether this tachycardia leads to clinically significant morbidity, it can trigger physician alarm and lead to extensive work-up. In this study, we aim to evaluate the predictors, evaluation, and outcomes associated with postoperative tachycardia in deep inferior epigastric perforator (DIEP) flap patients.

[METHODS]  A retrospective review of DIEP flap patients between 2011 and 2020 was performed. Variables examined included demographics, preoperative laboratories and heart rate (HR), and intraoperative factors. Work-up of postoperative tachycardia and adverse postoperative events was noted. Tachycardia was defined as persistent HR of 100 beats/min or more for at least 12 consecutive hours following surgery. Tachycardic patients were compared with non-tachycardic patients using regression analysis.

[RESULTS]  In total, 249 patients (439 flaps) were included in this study. Sixty-one patients (24.9%) developed tachycardia postoperatively. Regression analysis revealed that preoperative HR ( = 0.002) and flap weight ( = 0.037) predicted the development of tachycardia. While tachycardic patients were significantly more likely to undergo additional imaging and specialty consultations ( <0.05), they were not at higher risk for most postoperative complications, with the exception of delayed abdominal donor-site healing.

[CONCLUSION]  A significant number of DIEP flap patients can be expected to develop persistent tachycardia postoperatively. Isolated tachycardia should be considered a relatively benign finding that does not warrant extensive work-up or prolonged inpatient monitoring. Having the ability to predict tachycardia using preoperative HR and flap weight arms plastic surgeons with the confidence to limit costly work-up.