Houston and Dallas, Texas From the Department of Plastic Surgery, Baylor College of Medicine, and the Department of Plastic Surgery, University of Texas Southwestern Medical Center.
Plast Reconstr Surg. 2010 Jan;125(1):352-362. doi: 10.1097/PRS.0b013e3181c2a3b4.
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.
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.
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).
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.
为了确保患者接受适当的血栓栓塞预防，其他专业已开始使用风险分层模型。由于这些模型不包括整形外科患者，因此必须进行研究以探索与这些手术相关的风险。对文献进行了系统回顾，以解决这些问题。
对所有讨论腹部整形手术的文章进行了全面搜索。通过回顾病历收集了来自本机构的数据，并将其纳入分析。根据报告情况，将手术分为四组：单纯腹部整形术、腹部整形术加腹腔内手术、腹部整形术加另一种整形手术和腹部环形整形术。记录静脉血栓栓塞的频率。进行卡方分析以检查统计学差异。
共审查了 114 篇文章，有 30 篇文章纳入分析。腹部环形整形术的静脉血栓栓塞率最高（3.40%）。这与腹部整形术（0.35%）（p <0.0001）和腹部整形术联合整形手术（0.79%）（p <0.0001）的血栓栓塞率相比具有统计学意义。腹部整形术联合腹腔内手术的血栓栓塞率居第二位（2.17%）。这一比率高于单纯腹部整形术（p <0.001）和腹部整形术联合整形手术（p = 0.02）。
腹部环形整形术和与腹腔内手术联合进行的腹部整形术均显示出静脉血栓栓塞的风险显著增加。接受这些手术的患者应进行风险分层，并相应地管理围手术期预防措施。建议将这两种手术都纳入改良的 Davison-Caprini 风险评估模型中的更高暴露风险类别。
