Venous Thromboembolism in the Cosmetic Patient: Analysis of 129,007 Patients

Winocour, Julian; Gupta, Varun; Kaoutzanis, Christodoulos; Shi, Hanyuan; Shack, R. Bruce; Grotting, James C.; Higdon, Kent

doi:10.1093/asj/sjw173

Cited by 26 publications

(51 citation statements)

References 60 publications

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“…Some factors may contribute to infectious and thromboembolic processes, such as operative time, number of incisions, use of prosthesis, and patient-specific characteristics 5,[12][13][14][15][16] . Associated procedures accounted for 50% (4 out of 8) of SSIs and 87.5% (7 out of 8) of TEs, which corroborated other studies that assessed the prevalence of SSI and TEs in multiple clean surgeries using a post-discharge search approach [16][17][18] . Studies conducted in the states of São Paulo, Distrito Federal, and Minas Gerais found that most signs and symptoms of SSI manifested before the 15th postoperative day, confirming results from the present study, which found that 62.5% of cases of suspected SSI occurred during this period 17,19,20 .…”

Section: Discussionsupporting

confidence: 84%

“…In line with our results, a study by Oliveira in the state of Minas Gerais, Brazil, reported that 53% of the sample were effectively contacted 19 Active phoned search in the late postoperative period of plastic surgeries vs. 65.0% in the present study. It is worth noting that the process of surveillance is essential to increase accuracy, achieve more reliable indicators, and reduce underreporting 17,18,20 . Phoned search is a low cost and easy to perform method with importance on health care services and patient safety 12,13,20 .…”

Section: Discussionmentioning

confidence: 99%

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Active post-operative phoned search for late infections of surgical site and thromboembolic events in the late postoperative period of plastic surgeries in a day hospital in the municipality of Porto Alegre

Nicoletti¹,

Oliveira²,

Cioato

et al. 2018

Clin. Biomed. Res.

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Introduction: Elective and plastic surgical procedures are normally considered safer than emergency surgeries, although they cause concern to health services. The aim of this study was to analyze the active phoned search as a screening instrument for the diagnosis of surgical site infection (SSI) and thromboembolic events (TEs) in the late postoperative care of plastic surgeries in a private day hospital in the city of Porto Alegre. Methods: Quantitative, descriptive, retrospective, cross-sectional study. Data was collected from a database provided by phoned active search of sign and symptoms for epidemiological monitoring by the control infection service of a day-hospital, from July 2015 to February 2017. Results: A total of 3.595 patients were effective contacted in the indicated period. Among these patients, 77.6% received guidance on TEs. Moreover, 0.4% and 0.2% of patients reported signs and symptoms of SSI and TE, respectively. Associated procedures caused 50.0% of SSIs and 87.5% of TEs. Phoned search increased in 0.2% the number of reported cases of both adverse events in the overall sample. Conclusion: SSI and TE are worrying events for health institutions, since they can put patient safety at risk. Therefore, the data obtained in this study were used as a basis to qualify phoned search as an effective screening instrument for SSI and TE and provided support for the development of more consistent phoned search mechanisms for monitoring these postoperative events.

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Section: Discussionsupporting

confidence: 84%

Section: Discussionmentioning

confidence: 99%

Active post-operative phoned search for late infections of surgical site and thromboembolic events in the late postoperative period of plastic surgeries in a day hospital in the municipality of Porto Alegre

Nicoletti¹,

Oliveira²,

Cioato

et al. 2018

Clin. Biomed. Res.

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“…The incidence of VTE in aesthetic surgery cases was found to be relatively low at 0.09%, however, this risk significantly increased with combined procedures 3 . The incidence of symptomatic VTE was reported to be high after post-bariatric body contouring surgery, especially when combined with circumferential abdominoplasty (7.7%), abdominoplasty (5.0%) and breast or upper body contouring (2.9%) procedures 4 .…”

Section: Introductionmentioning

confidence: 89%

Systematic review of the venous thromboembolism risk assessment models used in aesthetic plastic surgery

et al. 2021

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Background A reliable venous thromboembolism (VTE) risk assessment model (RAM) can assist surgeons in identifying patients who would benefit from VTE prophylaxis. This systematic review was aimed at summarising the current available evidence on VTE RAMs used in aesthetic plastic surgery. Methods A comprehensive search was performed in the PubMed, EMBASE and Cochrane databases to include primary studies describing VTE RAMs in aesthetic plastic surgery from 1946 to February 2019. The objective was to compare the different VTE RAMs described for aesthetic plastic surgery to recommend a reliable model to stratify patients. Results Of the 557 articles identified in the PubMed, EMBASE and Cochrane databases, six articles were included in the final review. Five different RAMs were used in the included studies: Caprini 2005 RAM, Caprini 2010 RAM, Davison-Caprini 2004 RAM, the American Society of Anaesthesiologist's (ASA) physical status grading system and a tool developed by Wes et al. The difference in risk weightage amongst the tools along with the VTE incidences for different categories was compared. The Caprini 2005 RAM was the most widely reported tool and validated in plastic surgery patients. Conclusion Amongst the five different tools currently used, the Caprini 2005 RAM was the most widely reported. This tool was validated in plastic surgery patients and reported to be a sensitive and reliable tool for VTE risk stratification; therefore, current data support its use until further higher quality evidence becomes available. Because of the heterogeneity of the data and low quality of the current evidence, a definitive recommendation cannot be made on the best VTE RAM for patients undergoing aesthetic plastic surgery. This paper highlights the need for randomised controlled trials evaluating the various RAMs which are essential to support future recommendations and guidelines.

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“…115-117 Early and frequent ambulation—all patients are ambulating within 20 minutes of entrance to PACU, and every 2 hours thereafter with assistance. 118-120 Modified Aldrete Score, modified PADS, fast track discharge criteria 121-123 Increased inspired oxygen in PACU 124 Generous PO fluids—patient must “replace” typical IV fluids. Discharge without void in low-risk cases.…”

Section: Eras Bl Protocolmentioning

confidence: 99%

“…Early and frequent ambulation—all patients are ambulating within 20 minutes of entrance to PACU, and every 2 hours thereafter with assistance. 118-120…”

Section: Eras Bl Protocolmentioning

confidence: 99%

An Enhanced Recovery After Surgery (ERAS) Protocol for Outpatient BodyLift Surgery

Nuveen

Matthesen²,

Cox

et al. 2020

Am J Cosmet Surg

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The concept of enhanced recovery after surgery (ERAS) was developed in 2001 in order to create a multimodal, scientifically based approach to the development and audit of protocols for improving outcomes after surgical procedures. These protocols undergo constant evolution and evaluation toward the goal of quality of recovery. The BodyLift (BL) is the procedure that most comprehensively addresses the cosmetic needs of patients after massive weight loss (MWL). In the course of performing 136 consecutive outpatient BL surgeries over 7 years, we have developed a management protocol that has provided consistently high patient satisfaction, minimized frequent complications, and has documented 100% safety in all cases performed without deep vein thrombosis (DVT), transfusion and with 1 postoperative hospital admission. Each evidence-based component in the protocol was instituted to reduce risk of complications known to be most commonly associated with circumferential body contouring surgery. ERAS protocols are now widely used in many other surgical subspecialties. These protocols have the common goal of returning the patient to normal function as expeditiously as possible and are associated with decreased complications as well as shorter length-of-stay (LOS) and reduced costs. We have enumerated the many components of our protocol and aligned each with elements of an ERAS paradigm. In our retrospective review of 7 years of BL surgery (n = 136), this protocol has reduced both major and minor complications to previously unpublished levels. Our independently formulated ERAS protocol for outpatient BL surgery aligns closely with the ERAS concept, limiting surgical stress, thus reducing complications and affording a smooth and predictable perioperative experience. This is of importance for elective cosmetic surgery patients, who often have high expectations for an uneventful recovery and are unaccepting of potentially out-of-pocket costs associated with complications.

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Venous Thromboembolism in the Cosmetic Patient: Analysis of 129,007 Patients

Abstract: The incidence of VTE after cosmetic procedures is relatively low. However, the risk increases with combined procedures as well as with particular body areas, most notably trunk and extremities. Equally, significant patient risk factors exist, including BMI and age.

Cited by 26 publications

References 60 publications

Active post-operative phoned search for late infections of surgical site and thromboembolic events in the late postoperative period of plastic surgeries in a day hospital in the municipality of Porto Alegre

Active post-operative phoned search for late infections of surgical site and thromboembolic events in the late postoperative period of plastic surgeries in a day hospital in the municipality of Porto Alegre

Systematic review of the venous thromboembolism risk assessment models used in aesthetic plastic surgery

An Enhanced Recovery After Surgery (ERAS) Protocol for Outpatient BodyLift Surgery

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