Monday, October 13, 2014: 8:25 AM
Ari M Wes, BA
,
Plastic Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
John P Fischer, MD
,
Plastic Surgery, University of Pennsylvania, Philadelphia, PA
Jonas A Nelson, MD
,
Plastic Surgery, University of Pennsylvania, Philadelphia, PA
Joseph M. Serletti, MD
,
Plastic Surgery, University of Pennsylvania, Philadelphia, PA
Stephen J. Kovach, MD
,
Division of Plastic Surgery, University of Pennsylvania, Philadelphia, PA
Liza C. Wu, MD
,
Division of Plastic Surgery, University of Pennsylvania, Philadelphia, PA
Purpose: To
examine the incidence and predictors of venous thromboembolism (VTE) following
body contouring procedures.
Methods:
We reviewed the American College of
Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database
from 2005 to 2012 for all identifiable body contouring cases. A bootstrap analysis
and multivariable logistic regression analyses (MVR) were used to determine
independent predictors of VTE. Odds ratios from the MVR were then used to
define risk magnitudes for each significant predictor, and each patient's risk
score was totaled.
Results:
Seventeen thousand seven hundred and
seventy four patients underwent body contouring during the study period.
Average BMI of patients undergoing body contouring was 31.4 kg/m2, while 2,137
individuals were morbidly obese (BMI ³ 40 kg/m2). The most common areas of
intervention were the breast and abdominal regions (N=11,881, 66.8%; N=5,501,
30.9% respectively). 16,306 (91.7%) patients underwent an isolated contouring
procedure, while 1,293 (7.3%) underwent 2 procedures, and 175 (1.0%) underwent 3.
VTE
occurred in 99 (0.56%) individuals. Multivariate logistic regression revealed
that age greater than 45 years (45-60 years: OR 1.54, P=0.1; >60 years: OR
3.1, P<0.001), undergoing abdominal contouring (OR 3.33, P<0.001),
obesity (30²BMI<35: OR 3.30, P<0.001; 35²BMI<40: OR 4.26, P<0.001;
BMI³40: OR 3.09, P=0.001;), and being admitted as an inpatient (OR 3.01,
P<0.001) were associated with an increased odds of VTE. Each of the
aforementioned variables were assigned rounded risk scores (Table 1), with patients'
total scores being categorized as low (0-4), medium (5-7), or high risk (8-9).
The low risk cohort exhibited a VTE incidence of 0.15%, while the medium risk
cohort experienced an incidence of 1.12%, and the high risk group a VTE
incidence of 3.03% (Figure 1).
Conclusion:
This study identifies predictors of
VTE and defines a simple risk scoring model using a large, prospective dataset.
These findings show that in the presence of certain risk factors incidence of
VTE increases dramatically; in these cases VTE prophylaxis my be warranted.
Figure
1. Risk Scoring Model
Table
1. Risk factor weights.
Risk Factor | Risk Points |
Age: 45-60 Years | 1 |
Age: >60 Years | 2 |
Abdominal Contouring | 2 |
In-Patient | 2 |
30<BMI<35 | 2 |
35<BMI<40 | 3 |
BMI > 40 | 3 |
![[ Visit Client Website ]](images/banner.gif)