ePlasty: Vol. 11
Flap Complications and Thrombophilia: An Evidence-Based Model and Cost Analysis for Preoperative Screening*
Kendra G. Bowman, MD, PhD,a and Matthew J. Carty, MDb

aDepartment of Surgery, Brigham and Women's Hospital, Boston, MA and bDivision of Plastic Surgery, Department of Surgery, Brigham and Women's and Faulkner Hospitals, Boston, MA.

Correspondence: mcarty@partners.org

Background: Preoperative screening for thrombophilias in free flap candidates may be cost-effective. Methods: We developed a model for thrombogenic flap complications using reported thrombophilia prevalences and thromboembolic risk ratios, as well as free flap complication rates from our institution. We performed a break-even and incremental cost-effective ratio analysis for several screening and intervention scenarios. Results: Our thrombotic free flap complication rate is 4.9%. A full thrombophilia screen breaks even when the cost of complication exceeds $57 000 per patient; a limited screen breaks even at $39 000, and a scenario in which all patients undergo chemoprophylaxis breaks even at $49 000. Incremental cost-effective ratio analyses estimate a cost per avoided flap complication of $33 638 for a full panel scenario, $15 617 for a limited panel scenario and $25 455 for an all therapy scenario. Conclusions: Our analyses show that preoperative thrombophilia screening may be a cost-effective measure for the prevention of free flap thrombotic complications.