DVT and Abdominoplasty: A Holistic 8-point Protocol Based Approach to Prevent DVT

Background Plastic surgery as a specialty is afflicted with one of the highest incidence rates of thromboembolic events, with abdominoplasty procedures known to assimilate the greatest rates of Deep Vein Thrombosis (DVT). Objectives To develop a prophylactic protocol to reduce the rate of DVT occurrence post-abdominoplasty. Methods A total of 1078 abdominoplasty patients were enrolled onto an 8-point prophylaxis protocol with an inclusive holistic approach over a 7-year period. A 4-week smoking, HRT and COC cessation period was imposed on all patients and a maximum BMI score of 40 was required of all preoperative patients. Participants were administered with compression stockings, flowtrons and enoxaparin. Individuals with a DVT history were also required to be 1-year treatment free prior to surgery. Furthermore, the protocol necessitated post-operative deambulation of fit patients within 4 hours. Results Between 2008 and 2013, no incidence of DVT was recorded in all 1078 abdominoplasty surgery patients, indicating the potential for this protocol to lead to a significantly lower incidence than any previously published methodology. Different hypotheses of DVT proportions were investigated to identify rates statistically significant with our sample, thereby providing conservative incidence rate estimates. Conclusions This 8-point DVT prophylaxis protocol is the first non-criteria based inclusive protocol aimed at preventing abdominoplasty-associated DVT. As a result, not a single incident of DVT was recorded over the seven-year period of this study. We believe that a holistic and procedure-specific approach to prophylaxis can drastically reduce the occurrence of DVT in abdominoplasty surgery. With over 116,000 procedures performed annually in the United States, abdominoplasty has become one of the most popular and sought-after surgeries in the plastic and cosmetic field 1. Despite its ever-increasing popularity and the advancement of techniques, abdominoplasty, as with any other surgery, has its complications. Such complications can include infection, seroma, haematoma, thrombosis, embolism, scarring and even death. Complications rates have been reported as high as 37%, with some studies reporting a 16% major complication rate 2. One of the most serious and troubling complications for both the surgeon and patient is deep vein thrombosis (DVT). With over 1 million patients tested, an estimated 250,000 cases of DVT are diagnosed per year in the United States alone.