The Impact of Chemoprophylaxis and Patients' Demographics on Bleeding After Abdominal Body Contouring Procedures.

BACKGROUND

Despite the current increase in body contouring surgery (BCS), the impact of preoperative chemoprophylaxis on bleeding after BCS remains undetermined.

METHODS

A single institution retrospective cohort study examined patients undergoing abdominal BCS (abdominoplasty, lower body lift, and/or liposuction). Outcomes included estimated blood loss (EBL), hemoglobin drop on the first post-operative day, drain output, length of hospital stay, and the need for surgical evacuation of hematoma or transfusion. Statistical tests performed included chi-square, Wilcoxon signed-rank, and linear regressions using R.

RESULTS

Of the 697 patients, 136 (19.5%) received no anticoagulation, 324 (46.5%) had preoperative anticoagulation, 209 (29.9%) received both preoperative and postoperative anticoagulation, and 28 (4%) had missing data. Preoperative LMWH was linked to a 45% increase in serosanguinous drain output on day one (145 ml vs. 100 ml; p < 0.001) but did not increase bleeding risk. Male patients had higher odds of hematoma (OR 14.8, p < 0.001), greater need for blood (OR 5.13, p < 0.001) or plasma (OR 6.15, p < 0.001) transfusion, more significant hemoglobin drop (- 2.23 +/- 1.06 g/dL vs. - 1.43 +/- 1.01 g/dL, p < 0.001), and higher drain output on day one (180 mL vs. 130 mL, p < 0.001) and overall (655 mL vs. 380 mL, p < 0.001). Previous obesity surgery patients also had higher odds for hematoma (OR 3.24, p = 0.011), blood transfusion (OR 3.26, p = 0.002), and increased drain output.

CONCLUSIONS

Preoperative chemoprophylaxis in BCS is associated with increased serosanguinous drain output without additional bleeding risk. Male gender and a history of obesity surgery increase the risk of hematoma, hemoglobin drop, and transfusion needs.

LEVEL OF EVIDENCE III

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