Venous Thromboembolism in Abdominoplasty: A Comprehensive Approach to Lower Procedural Risk

BACKGROUND: Venous thromboembolism (VTE) is a serious and potentially life-threatening surgical complication. However, there is little consensus regarding appropriate VTE prophylaxis for plastic surgery patients. Risk factors as they apply to plastic surgery patients are unclear, and recent recommendations for chemoprophylaxis in these patients may expose them to other additional risks. OBJECTIVES: The authors examine perioperative and intraoperative measures, specifically those that have enabled a large number of patients to undergo outpatient abdominoplasty safely, with a reduced risk of VTE. METHODS: A retrospective review was performed of 404 consecutive abdominoplasty patients who were treated at a single outpatient surgery center between 2000 and 2010. Graded compression stockings and intermittent pneumatic compression devices were placed on all patients, and perioperative and intraoperative warming was strictly applied. Progressive tension suturing technique was performed in all cases and drains were eliminated. All patients received pain pumps, ambulated within one hour of surgery, and were discharged home the same day. Patient VTE risk factors were scored with the Caprini/Davison risk assessment model (RAM). Perioperative and intraoperative measures were taken to reduce factors that may increase VTE risk in abdominoplasty. Complications were recorded, including VTE events, seromas, hematomas, and infections. RESULTS: In this series, 247 abdominoplasty procedures were performed alone and 157 were combined with additional procedures. Under the RAM, 297 patients were considered "high risk" and 17 "highest risk." Abdominoplasty operative time was 100 ± 29 minutes. Only one case of deep vein thrombosis (DVT) occurred, in the calf. CONCLUSIONS: A comprehensive approach to perioperative and intraoperative patient care has allowed outpatient abdominoplasty to be safely performed without VTE chemoprophylaxis in patients with fewer than six risk factors.