PURPOSE: Venous thromboembolism (VTE) is a recognized and highly morbid complication of plastic surgical procedures. Although rare after cervicofacial rhytidectomy, it is a potential complication of this procedure and significantly more likely in instances of combined procedures. We are concerned that some surgeons may elect not to give deep venous thrombosis (DVT) prophylaxis postoperatively, in rhytidectomy or combined procedures patients, out of concern about the potential for hematoma at the facelift site. We aim to examine whether postoperative VTE prophylaxis with enoxaparin increases the risk of postoperative bleeding complications after these procedures.
METHODS: All research was performed with approval of the University of Michigan Institutional Review Board (HUM00153351). Patients undergoing cervicofacial rhytidectomy procedures (facelift and neck lift via periauricular incisions) between 2006 and 2018 were recorded. Demographic factors were recorded and the Caprini score as documented at the time of surgery. Patients who received postoperative DVT chemoprophylaxis received enoxaparin 40 mg starting ≥6 hours postoperatively, per our institution’s usual guidelines. The choice between receipt of postoperative VTE chemoprophylaxis or not was at the discretion of the treating surgeons. All hematomas and other complications were managed appropriately and documented.
RESULTS: Eighty-six patients underwent facelift and neck lift at the University of Michigan between 2006 and 2018. Thirteen of these patients (15%) received postoperative DVT prophylaxis with enoxaparin 40 mg within the 24 hours after surgery (range, 6.5–19.8 hours). The rate of hematoma was 7.7% in the group that received enoxaparin and 6.8% in the group that did not; the difference was not significantly different (P = 1.0). The groups were otherwise similar, except that the group receiving enoxaparin had a higher mean body mass index than the group that did not (28.2 versus 25.0; P = 0.01). No VTE was observed in either group, and the mean Caprini score was similar between groups (4.5 versus 4.6; P = 0.66). In multivariate logistic regression controlling for age, gender, and body mass index, enoxaparin administration was not associated with hematoma development (odds ratio = 1.30; P = 0.84; 95% confidence interval = −2.24 to 2.76).
CONCLUSIONS: In patients undergoing cervicofacial rhytidectomy, administration of enoxaparin 40 mg beginning ≥6 hours after surgery does not seem to significantly increase the rate of hematoma requiring intervention.