Flap Complications and Thrombophilia: An Evidence-Based Model and Cost Analysis for Preoperative Screening*

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.