Dataset Information

Body Contouring in Massive Weight Loss Patients Receiving Venous Thromboembolism Chemoprophylaxis: A Systematic Review.

ABSTRACT: Venous thromboembolism (VTE) events are the leading cause of morbidity and mortality in plastic surgery. Currently, there is no consensus regarding the use of VTE chemoprophylaxis in the context of the risk for bleeding following specific body contouring procedures. Furthermore, there is increasing popularity of these procedures in the massive weight loss (MWL) patient population, who may be at higher risk due to multiple risk factors. The purpose of this study was to stratify the incidence of VTE and bleeding events among individual, specific body contouring procedures in MWL patients receiving chemoprophylaxis.

Methods

A systematic review was designed according to PRISMA guidelines. We screened all articles published between 1988 and 2018 reporting chemoprophylaxis status, VTE, and bleeding events in MWL patients undergoing body contouring procedures.

Results

Thirty-one publications were reviewed. The VTE incidence for any procedure was too low to reach significance. Overall, hematoma incidence in single-procedure patients (8.7%) was significantly higher than concomitant-procedure patients (4.2%, P < 0.01). However, when stratified into operative and nonoperative hematomas, no significant difference between single- and concomitant-procedure groups overall was demonstrated for either category. Individually, only thighplasty patients had a higher rate of operative hematomas when undergoing thighplasty alone (5.3%) compared with thighplasty with concomitant procedures (0.6%, P < 0.05).

Conclusions

Overall, MWL patients undergoing single body contouring procedures (among abdominoplasty, belt lipectomy, thighplasty) were found to have a higher risk of hematoma compared with those undergoing combined contouring procedures. However, stratified hematoma data revealed no differences in overall risk between single- and multiple-procedure operations.

SUBMITTER: Yin C

PROVIDER: S-EPMC8367044 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:ObjectiveVenous thromboembolism (VTE) is reported to occur in up to 33% of patients undergoing major vascular surgery. Despite this high incidence, patients inconsistently receive timely VTE chemoprophylaxis. The true incidence of VTE among patients receiving delayed VTE chemoprophylaxis is unknown. We sought to identify the association of VTE chemoprophylaxis timing on VTE risk, postoperative transfusion rates, and 30-day mortality and morbidity in patients undergoing major open vascular surgery.MethodsPatients undergoing major open vascular surgery (open abdominal aortic aneurysm [oAAA] repair, aortofemoral bypass, and lower extremity infrainguinal bypass [LEB]) were identified using the Michigan Surgical Quality Collaborative (MSQC) between July 2012 and June 2015. The VTE rate was compared between patients receiving early versus delayed VTE chemoprophylaxis. VTE chemoprophylaxis delay was defined as therapy initiation more than 24 hours after surgery. The risk-adjusted association of the chemoprophylaxis timing and VTE development was determined using multivariable logistic regression. Blood transfusion rates, 30-day mortality, and postoperative complications were compared across groups.ResultsA total of 2421 patients underwent major open vascular surgery, including 196 oAAA repair, 259 aortofemoral bypass, and 1966 LEB. The overall incidence of 30-day VTE was 1.40%, ranging from 1.12% for LEB to 3.57% for oAAA repair. Among patients receiving early VTE chemoprophylaxis, the rate of VTE was 0.78% versus 2.26% among those with a delay in VTE chemoprophylaxis (P = .002). When accounting for the preoperative risk of VTE, delayed chemoprophylaxis was associated with a significantly higher risk of VTE (odds ratio, 2.38; 95% confidence interval, 1.12-5.06; P = .024). The early VTE chemoprophylaxis group was associated with a significantly decreased risk of bleeding compared with those with a delay (14.31% vs 18.90%; P = .002). Overall 30-day mortality and postoperative complications were similar with the exception of an associated higher rate of infectious complications in the delayed VTE chemoprophylaxis group, including superficial surgical site infection (6.00% vs 4.06%; P = .028), pneumonia (3.25% vs 1.85%; P = .028), urinary tract infection (2.95% vs 1.57%; P = .020), and severe sepsis (3.05% vs 1.71%; P = .029).ConclusionsAlthough patients undergoing major open vascular surgery have a low risk of VTE at baseline, there is a significantly greater risk of developing VTE among patients who have a delay in the administration of VTE chemoprophylaxis. Postoperative transfusion rates were significantly lower among patients receiving early chemoprophylaxis. There were no differences in the 30-day mortality and postoperative complications, except for infectious complications. Given these findings, surgeons should consider early chemoprophylaxis in the postoperative setting after major open vascular surgery without contraindication.

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