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Factors Impacting Thromboembolism after Bariatric Body Contouring Surgery

Shermak, Michele A. M.D.; Chang, David C. Ph.D., M.P.H., M.B.A.; Heller, Jennifer M.D.

Plastic & Reconstructive Surgery: 15 April 2007 - Volume 119 - Issue 5 - pp 1590-1596
doi: 10.1097/01.prs.0000256070.37066.7e
Cosmetic: Original Articles

Background: The purpose of this study was to define the risk of venous thromboembolism within the massive weight loss population undergoing body contouring procedures.

Methods: Retrospective analysis of massive weight loss patients who had body contouring operations between March of 1998 and September of 2004 was performed. Patient factors studied included age, gender, medical comorbidities including history of thromboembolic complications, depression, tobacco use, preoperative/postoperative body mass index, surgery, and transfusion.

Results: There were 138 cases, and the female-to-male ratio was 5:1. Procedures were often combined: 128 patients had abdominal surgery, 36 had a back lift, 41 had brachioplasty, 29 had chest surgery, and 47 had a thigh lift. The most common complications were related to healing (n = 28) and seroma (n = 18). Three patients had postoperative deep venous thrombosis requiring anticoagulation, and one had a fatal pulmonary embolism, making the overall venous thromboembolism risk 2.9 percent. The mean body mass index at contour was 48.5 for patients with venous thromboembolism versus 31.8 for patients who did not develop venous thromboembolism (p = 0.01). Looking at this subgroup of 45 patients, the risk of venous thromboembolism was 8.9 percent, with no risk found in patients with a body mass index less than 35 (p = 0.01).

Conclusions: The risk of venous thromboembolism with contouring surgery for massive weight loss is comparable to that for gastric bypass surgery. Body mass index in the obese range appears to be a leading risk factor. The authors' data support routine prophylaxis against venous thromboembolism. Recommendations for high-risk patients are discussed.

Baltimore, Md.

From the Department of Surgery, Divisions of Plastic Surgery and Vascular Surgery, The Johns Hopkins Medical Institutions.

Received for publication August 10, 2005; accepted January 12, 2006.

Presented at The Plastic Surgery at the Red Sea, in Eilat, Israel, in March of 2005.

Michele A. Shermak, M.D., Division of Plastic Surgery, Johns Hopkins Bayview Medical Center, Suite A518, Baltimore, Md. 21224, masherma@jhmi.edu

©2007American Society of Plastic Surgeons