Renaissance School of Medicine, Stony Brook University, Stony Brook, NY, USA.
Division of Plastic Surgery, Department of Surgery, Stony Brook University, Stony Brook, NY, USA.
Aesthet Surg J. 2021 Oct 15;41(11):1279-1289. doi: 10.1093/asj/sjab090.
Many plastic surgeons avoid the administration of venous thromboembolism (VTE) chemoprophylaxis out of concern for surgical bleeding in abdominoplasty. Although previous studies have attempted to address the relationship between abdominoplasty and bleeding or VTE, poor reporting techniques remain a challenge. As a result, there has been a lack of reliable data to guide clinical practice.
The authors sought to determine the prevalence of bleeding and VTE in abdominoplasty with and without chemoprophylaxis.
A systematic review was performed following PRISMA guidelines utilizing PubMed, CINAHL, and Cochrane Central. Patient demographics, comorbidities, risk category (if available), bleeding events, VTE events, and chemoprophylaxis information were recorded.
Across 10 articles, 691 patients received chemoprophylaxis in the setting of abdominoplasty: 68 preoperatively, 588 postoperatively, and 35 received both; 905 patients did not receive chemoprophylaxis. A total of 96.8% of patients were female, 73% underwent concomitant liposuction, and none were clearly risk stratified. The overall incidence of VTE and bleeding was 0.56% (9/1596) and 1.6% (25/1596), respectively. Compared with no chemoprophylaxis, chemoprophylaxis was not associated with increased incidence of bleeding (1.3% [9/671] vs 0.91% [8/881], P = 0.417) or decreased incidence of VTE (0.87% [6/691] vs 0.33% [3/901], P = 0.187).
The prevalence of bleeding in abdominoplasty was low. Chemoprophylaxis was not associated with increased risk of bleeding or decreased risk of VTE, though the lack of risk stratification and heterogeneity of the cohort precludes firm conclusions. This study underscores the importance of utilizing validated risk-stratification tools to guide perioperative decision-making.
许多整形医生出于对腹部整形手术出血的担忧，避免使用静脉血栓栓塞症（VTE）化学预防。尽管先前的研究试图解决腹部整形术与出血或 VTE 之间的关系，但报告技术不佳仍是一个挑战。因此，缺乏可靠的数据来指导临床实践。
作者旨在确定有和没有化学预防的腹部整形术中出血和 VTE 的发生率。
根据 PRISMA 指南，利用 PubMed、CINAHL 和 Cochrane Central 进行系统评价。记录患者人口统计学、合并症、风险类别（如有）、出血事件、VTE 事件和化学预防信息。
在 10 篇文章中，691 例患者在腹部整形术时接受了化学预防：68 例术前，588 例术后，35 例同时接受；905 例未接受化学预防。患者中 96.8%为女性，73%同时行脂肪抽吸术，且均未明确风险分层。VTE 和出血的总发生率分别为 0.56%（9/1596）和 1.6%（25/1596）。与未行化学预防相比，化学预防与出血发生率增加无关（1.3%[9/671]与 0.91%[8/881]，P=0.417），VTE 发生率降低无关（0.87%[6/691]与 0.33%[3/901]，P=0.187）。
腹部整形术的出血发生率较低。化学预防与出血风险增加或 VTE 风险降低无关，但缺乏风险分层和队列的异质性，无法得出明确的结论。本研究强调了使用经过验证的风险分层工具来指导围手术期决策的重要性。
