Introduction: Venous thromboembolism (VTE) and surgical site infection (SSI) have been identified as preventable surgical complications which are addressed by both the National Quality Forum (NQP) and the American College of Surgeons Surgical Care Improvement Project (SCIP) safe practice initiatives. We examined the historical practice patterns of our faculty as related to the compliance with these VTE and antibiotic prophylaxis initiatives. We then evaluated the subsequent incidence of adverse outcomes in abdominoplasty or panniculectomy patients. 
Methods: We performed retrospective chart reviews on 243 patients who underwent abdominoplasty or panniculectomy from 2000 to 2007, documenting demographics such as prior VTE, body mass index (BMI), age, length of operative procedure, type of anesthesia, oral contraceptive use, smoking, and adverse outcomes including deep venous thromboembolism (DVT) and pulmonary emboli (PE), SSI, hematoma, and death. Statistical analysis was completed using Student's t-test for continuous variables and Pearson's chi-square and Fisher's exact test for categorical variables. Significance was set at p < 0.05. Obesity was defined as BMI > 30 and morbid obesity as BMI > 40.
Results: Seventeen (7%) patients suffered complications. All (243) patients received at least one form of VTE prophylaxis. One patient had a DVT, and two had  PE. All three patients who suffered a thromboembolic event had been treated with an additional form of chemoprophylaxis (i.e., either heparin or lovenox). These three patients were morbidly obese. Seventy-four percent of patients received appropriate antibiotics. Thirteen (5.3%) patients developed significant postoperative infection requiring hospitalization, 12 (92%) of whom received appropriate antibiotics. Eleven (85%) of these 13 patients were obese, and 7 (54%) were morbidly obese. One patient (BMI 56.5) died of unrelated congestive heart failure. Obesity proved to be the only significant risk factor for an adverse outcome (p > 0.05).
Conclusion: In patients considered at risk, despite very good compliance with safe practice initiatives supported by NQF and SCIP, significant adverse outcomes occurred. Of all variables, obesity was the only pervasive risk factor. This study highlights the potential need for compliance with quality measures and demonstrates that adverse outcomes may result despite adherence to best surgical practices.