Procedural risk for venous thromboembolism in abdominal contouring surgery: A systematic review of the literature

Background: To ensure that patients receive appropriate thromboembolic prophylaxis, other specialties have begun using risk stratification models. Because these models do not include plastic surgery patients, research must be directed toward exploring the risk associated with these operations. A systematic review of the literature was performed to address these issues. Methods: A thorough search for all articles discussing abdominal contouring surgery was conducted. Data were collected from this institution through a retrospective chart review and included in the analysis. Procedures were divided into four groups, dependent on what was reported, as follows: abdominoplasty alone, abdominoplasty with an intraabdominal procedure, abdominoplasty with another plastic surgical procedure, and circumferential abdominoplasty. Frequencies of venous thromboembolism were recorded. Chi-square analysis was performed to examine for statistical differences. Results: One hundred fourteen articles were reviewed; 30 articles were included in the analysis. Circumferential abdominoplasty was associated with the highest venous thromboembolism rate (3.40 percent). This was statistically higher than the thromboembolic rate of abdominoplasty (0.35 percent) (p < 0.0001) and abdominoplasty with concomitant plastic surgery (0.79 percent) (p < 0.0001). Abdominoplasty combined with an intraabdominal procedure was associated with the second highest rate of thromboembolism (2.17 percent). This rate was higher than abdominoplasty alone (p < 0.001) and abdominoplasty with concomitant plastic surgery (p = 0.02). Conclusions: Circumferential abdominoplasty and abdominoplasty performed in combination with an intraabdominal procedure were demonstrated to have significantly increased risk for venous thromboembolism. Patients undergoing these procedures should be risk stratified and have perioperative prophylaxis managed accordingly. It is suggested that both of these operations be placed into a higher exposing risk category within the modified Davison-Caprini risk assessment model.