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Venous Thromboembolism after Abdominal Wall Reconstruction: A Prospective Analysis and Review of the Literature

Kraft, Casey T. M.D.; Janis, Jeffrey E. M.D.

Plastic and Reconstructive Surgery: May 2019 - Volume 143 - Issue 5 - p 1513-1520
doi: 10.1097/PRS.0000000000005534
Reconstructive: Trunk: Original Articles
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Background: Ventral hernias are a common problem after exploratory laparotomy, and plastic surgeons often become involved for hernia repair in complex situations. Plastic surgeons can achieve fascial closure through primary repair, an external oblique aponeurosis release, or a transversus abdominis release. Currently, there is scant literature evaluating venous thromboembolism rates after these procedures. The authors sought to evaluate their own experience with complex abdominal wall reconstruction and venous thromboembolism events.

Methods: The authors retrospectively reviewed their prospectively collected database of all patients who have undergone complex abdominal wall reconstruction performed by a single surgeon at their institution from September of 2013 to February of 2018. Demographic data, anticoagulant use, Caprini score, operative time, and postoperative venous thromboembolism events were recorded. A literature search was also performed, identifying all published articles evaluating venous thromboembolism events after abdominal wall reconstruction.

Results: The authors identified 175 patients for analysis. Four patients were found to have postoperative venous thromboembolism events, for a total venous thromboembolism rate of 2.3 percent. The average Caprini score for these patients was 8.5, compared to 5.26 for those without a venous thromboembolism event, and no deaths were reported from these complications. On literature review, three articles were identified in the literature discussing venous thromboembolism after abdominal wall reconstruction, all based on the American College of Surgeons National Surgical Quality Improvement Program database.

Conclusions: Patients undergoing complex abdominal wall reconstruction are at high risk for venous thromboembolism events. There is scant literature published on this topic, but surgeons should be aware of the risk for venous thromboembolism after complex abdominal wall reconstruction and work to minimize this risk as much as possible.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

Patient Safety CME.This and Related “Classic” Articles Appear on Prsjournal.com for Journal Club Discussions.

Columbus, Ohio

From the Department of Plastic Surgery, The Ohio State University Wexner Medical Center.

Received for publication August 12, 2018; accepted November 1, 2018.

Disclosure:Dr. Janis has served as a consultant for LifeCell, Bard, Pacira, and Allergan more than 12 months ago but has no current active affiliations. He receives royalties from Thieme Publishing. Dr. Kraft has no conflicts of interest to disclose. No funding was received for this research.

By reading this article, you are entitled to claim one (1) hour of Category 2 Patient Safety Credit. ASPS members can claim this credit by logging in to PlasticSurgery.org Dashboard, clicking “Submit CME,” and completing the form.

Jeffrey E. Janis, M.D., Department of Plastic Surgery, The Ohio State University Wexner Medical Center, 915 Olentangy River Road, Suite 2100, Columbus, Ohio 43212, jeffrey.janis@osumc.edu, Twitter: @CaseyKraftMD, Instagram: @CaseyKraftMD

Copyright © 2019 by the American Society of Plastic Surgeons