Abstract - Confex



Choosing the Right DVTDVT Prophylaxis in the Massive Weight Loss Patient

Authors: Alan H. Chen, M.D.; Carolyn Rogers, B.S.; Angela Song, M.D.; Lawton Tang, M.D.; James O’Toole, M.D.; Ian L. Valerio, M.D., M.S., M.B.A., and J. Peter Rubin, M.D.

Institutional Affiliation: University of Pittsburgh Medical Center

Presenter’s Mailing Address: 3550 Terrace Street, Scaife Hall Suite 6B

Pittsburgh, PA 15261

Presenter’s Contact Information:

(H): 909-418-7772 (C):909-418-7772 (O): 412-648-9670 (Fax): 412-648-1987

Email: chenah@upmc.edu

Author Category: Resident

Presentation Category: Clinical Research

Abstract Category: Aesthetics

Introduction: The appropriate DVT prophylaxis remains unclear in post-massive weight loss body contouring (BC) patients considering their rich subcutaneous vascularity. We report the efficacy of sequential compression devices (SCDs) and early ambulation in BC patients, with chemical prophylaxis added only for patients at high risk for DVT.

Methods: Clinical outcomes were identified for all post-massive weight loss patients who underwent BC by one surgeon. Patients with weight loss due to bariatric surgery or diet and exercise were included. Method of DVT prophylaxis used, and complications such as DVT/PE, post-operative bleeding, and re-operation were analyzed, along with method of DVT prophylaxis.

Results: Two-hundred ninety-nine BC patients with 346 anesthetic events were analyzed. Pre-inductive SCDs were employed inere placed before 323 (93.35%) events. Intra-operative time averaged 4.52+/-3.22 hours. Eighteen Ppatients (5.20%) at high risk for DVT received anti-coagulation with Lovenox, heparin, or Fragmin were given chemical prophylaxis prior to 18 (5.20%) eventreoperativelys. All patients had SCDs ordered postoperatively and were encouraged to ambulate within 24 hours. Hematomas occurred after 16 (4.62%) events. Seven (2.02%) patients required re-operation for bleeding, with 2 (11.1%) having received and 5 (1.52%) not having received chemical chemical prophylaxisanti-coagulation. No clinically significant DVT/PE occurred.

Conclusions: SCDs and early ambulation appear effective against development of clinically significant DVT in BC patients with low to moderate risk for thrombosis. There is a tendency toward bleeding complications in this population, making chemical prophylaxis less desirable.

Final Abstract

IntroductionNTRODUCTION: There are estimated 200,000 deaths from pulmonary embolism per year in the U.S. accounting up to 5 percent of postoperative deaths (1). A study of 500 patients in five surgical specialties (general surgery, orthopedics, gynecological surgery, genitourinary surgery and vascular surgery) indicated that the incidence of DVT in can be as high as 36% when no DVT prophylaxis was used (2). The reported incidences of DVT and PE in plastic surgery range from 0.39% to 1.1%, and 0.16% to 0.8%, respectively (3-6). The appropriate DVT prophylaxis remains unclear in post-massive weight loss patients who undergo body contouring (BC) patientoperations. The rich subcutaneous vascularity in these patients raises concern over bleeding risk, which may be exacerbated by chemical DVT prophylaxis. considering their rich subcutaneous vascularity. We report the efficacy of sequential compression devices (SCDs) and early ambulation in post-massive weight loss body contouringBC patients., Cwith chemical prophylaxis was used inadded only for patients at who are at high risk for DVT.

MethodsMETHODS: CClinical outcomes were identified analyzed for all post-massive weight loss patients who underwent body contouring operationsBC by one surgeon from December, 2002 to January, 2006.

The mMethod of DVT prophylaxis used, and complications such as DVT/PE, post-operative bleeding, and the need for re-operation were analyzed.

ResultsRESULTS: Two-hundred ninety-nine BC body contouring patients with 346 anesthetic events were analyzed. Pre-inductive SCDs sequential compression devices were employed in 323 (93.93.4 35%) events. Intra-operative time averaged 4.52+/-3.22 hours. Eighteen patients (5.25.2 0%) at high risk for DVT were given chemical prophylaxis preoperatively. These patients were given heparin, lovenox, or fragmin. All patients had SCDs sequential compression devices ordered postoperatively, and were encouraged to ambulate within 24 hours. Hematomas occurred after 16 (4.64.6 2%) events. A total of Seven7 (2.02.0 2%) patients required re-operation for bleeding., with 2Two (11.1%) of the patients whohaving received chemical prophylaxis, and 5 (1.51.5 2%) of the patients who not having received chemical prophylaxisdid not received chemical prophylaxis required re-operation for bleeding. No clinically significant DVT/PE occurred.

ConclusionsCONCLUSION: In this study, we found that SCDs sequential compression devices and early ambulation appear effective against development of clinically significant DVT in BC body contouring patients with low to moderate risk for thrombosis. However, Tthere is a tendency toward bleeding complications in theise massive weight loss patients population. Therefore,, making routine chemical prophylaxis appears to be less desirable in this patient population.

REFERENCE

1. Anderson, F. A., Wheeler, H. B., Goldberg, R. J., et al. A population-based perspective of the hospital incidence and case fatality rates of deep vein thrombosis and pulmonary embolism: The Worcester DVT Study. Arch. Intern. Med. 151: 933, 1991.

2. Geerts WH. Pineo GF. Heit JA. Bergqvist D. Lassen MR. Colwell CW. Ray JG. Prevention of venous thromboembolism: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. Chest. 126(3 Suppl): 338S-400S, 2004.

3. Reinish, J. F., Bresnick, S. D., and Walker, J. W., and Rosso, R. F. Deep venous thrombosis and pulmonary embolus after face lift: A study of incidence and prophylaxis. Plast. Reconstr. Surg. 107: 1570, 2001.

4. Grazer, F. M., and Goldwyn, R. M. Abdominoplasty assessed by survey, with emphasis on complications. Plast. Reconstr. Surg. 59: 513, 1977.

5. Hester, R. T., Jr., Baird, W., Bostwick, J., III, Nahai, F., and Cukic, J. Abdominoplasty combined with other surgical procedures: Safe or sorry? Plast. Reconstr. Surg. 83: 997, 1989.

6. Davison SP. Venturi ML. Attinger CE. Baker SB. Spear SL. Prevention of venous thromboembolism in the plastic surgery patient. Plast. Reconstr. Surg. 114(3): 43E-51E, 2004.

................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download