Wang Fei, Chemakin Katherine, Shamamian Peter, Punn Isha, Campbell Tessa, Ricci Joseph A
Division of Plastic Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, New York, NY, USA.
Aesthet Surg J. 2022 Dec 14;42(12):1435-1444. doi: 10.1093/asj/sjac195.
Rectus abdominis plication increases intra-abdominal pressure and lower-extremity venous stasis, which may increase the incidence of venous thromboembolism (VTE) events.
The aim of this study was to investigate the potential association between VTE and rectus abdominis muscle plication during surgery.
A retrospective review of all patients who underwent abdominal body contouring at the authors' institution between 2010 and 2020 was completed. Cases were those with postoperative VTEs and were matched to controls (1:4) via potential confounders. Variables collected include demographic data, operative details, comorbidities, and postoperative complications. Statistical analysis was performed with parametric, nonparametric, and multivariable regression modeling.
Overall, 1198 patients were included; 19 (1.59%) experienced a postoperative VTE and were matched to 76 controls. The overall cohort was 92.7% female with an average age of 44 years, an average Charlson Comorbidity Index of 1 point, and an average BMI of 30.1 kg/m2. History of cerebrovascular events (14.5% vs 36.8%, P = 0.026) differed significantly between cohorts, but no significant associations were noted in all other baseline demographics. Additionally, VTE cases were more likely to have received intraoperative blood transfusions (odds ratio = 8.4, P = 0.04). Bivariate analysis demonstrated cases were significantly more likely to experience concurrent complications, including delayed wound healing (0% vs 5.3%, P = 0.044), seroma formation (5.3% vs 21.1%, P = 0.027), and fat necrosis (0% vs 5.3%, P = 0.044). However, these findings were not significant in a multivariable regression model. Plication was not associated with VTE outcomes.
Rectus plication does not increase the risk of VTE. However, the odds of VTE are significantly increased in patients who received intraoperative blood products compared with those who did not.
腹直肌折叠术会增加腹内压和下肢静脉淤滞，这可能会增加静脉血栓栓塞（VTE）事件的发生率。
本研究旨在调查手术期间VTE与腹直肌折叠术之间的潜在关联。
对2010年至2020年间在作者所在机构接受腹部塑形手术的所有患者进行回顾性研究。病例为术后发生VTE的患者，并通过潜在混杂因素与对照组（1:4）进行匹配。收集的变量包括人口统计学数据、手术细节、合并症和术后并发症。采用参数、非参数和多变量回归模型进行统计分析。
总体而言，共纳入1198例患者；19例（1.59%）发生术后VTE，并与76例对照匹配。整个队列中女性占92.7%，平均年龄44岁，平均Charlson合并症指数为1分，平均BMI为30.1kg/m²。队列之间脑血管事件史（14.5%对36.8%，P = 0.026）差异显著，但在所有其他基线人口统计学特征中未发现显著关联。此外，VTE病例更有可能接受术中输血（比值比 = 8.4，P = 0.04）。双变量分析表明，病例更有可能并发并发症，包括伤口愈合延迟（0%对5.3%，P = 0.044）、血清肿形成（5.3%对21.1%，P = 0.027）和脂肪坏死（0%对5.3%，P = 0.044）。然而，在多变量回归模型中这些发现并不显著。折叠术与VTE结局无关。
腹直肌折叠术不会增加VTE风险。然而，与未接受术中血液制品的患者相比，接受术中血液制品的患者发生VTE的几率显著增加。
