Comparing microsurgical breast reconstruction outcomes following postoperative monitoring techniques: a systematic review and meta-analysis of 2529 patients

Aims: This paper aims to assess the existing evidence regarding oximetry and thermography by comparing postoperative rates of complications following microsurgical breast reconstruction. Methods: A systematic review of PubMed, Web of Science, and Cochrane was completed. A qualitative and quantitative analysis of all included studies was then performed. Results: Fourteen studies were included with a total population of 2,529 female patients who underwent microvascular breast reconstruction, ultimately totaling 3,289 flaps. The mean age for the cohorts included in this study ranged from 48.9 to 57 years of age. A total of 15 complete flap losses were reported. Furthermore, this meta-analysis of proportion showed that total flap loss experienced was 0% (95%CI 0%-100%) for patients monitored with thermography compared to 0% (95%CI 0%-1%) for those monitored with oximetry. Partial flap loss occurred at a frequency of 1% [95% confidence interval (CI) 0%-73%] for patients monitored with thermography compared to 1% (95%CI 0%-2%) for those monitored with oximetry. Furthermore, the results of this study showed that thermography prompted a return to the operating room (OR) in 1% (95%CI 0%-73%) of the patients compared to 5% (95%CI 3%-9%) for oximetry. Lastly, the overall complication rate was 12% (95%CI 1%-54%) for patients monitored with thermography compared to 10% (95%CI 4%-21%) for those monitored with oximetry. Conclusion: Ultimately, this meta-analysis concludes that while oximetry monitoring currently has strong evidence for improving flap outcomes, trends in the current data indicate that further studies may demonstrate that thermography may be comparable to oximetry in achieving similar patient outcomes.