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Venous thromboembolism unlikely to occur during plastic surgery

Patients undergoing plastic surgery were unlikely to develop venous thromboembolisms intraoperatively, exhibiting a different pathophysiology from that of orthopedic patients undergoing joint replacement, according to recently published study findings.

In the study, researcher Eric Swanson, MD, offered Doppler ultrasound screening to 200 consecutive plastic surgery patients undergoing 205 operations. Scans were scheduled preoperatively, the day after surgery and at roughly 1 week (range: 6-10 days) after surgery. At each visit, the Terason t3200 Ultrasound System Vascular Series (Terason Ultrasound) was used to view the deep veins of both lower extremities, including the calf veins.

Vessels imaged included the common femoral, great saphenous, superficial femoral, deep femoral, popliteal, posterior tibial and peroneal veins.

Surgeries were performed on an outpatient basis in a licensed ambulatory surgery center, and clinicians observed “SAFE” anesthesia principles: spontaneous breathing, avoid gas, face up and extremities mobile.

The researchers found there were no deaths, hospitalizations or patients with symptoms or signs of pulmonary embolism. A deep venous thrombosis was detected in only one screening examination in a patient undergoing lipoabdominoplasty and augmentation/mastopexy. This patient had no history of a venous thromboembolism or a clotting disorder, and her preoperative and day 1 postoperative ultrasound scans were negative. A thrombosis was seen in the left calf veins, involving the popliteal vein. She was placed on a regimen of subcutaneous enoxaparin 80 mg twice daily for 3 days, followed by rivaroxaban 15 mg by mouth twice daily for 2 weeks, then rivaroxaban 20 mg by mouth daily for 3 months. Five weeks after surgery, no sonographic evidence of a thrombosis was observed, according to the researchers.

Swanson concluded that the risk of a plastic surgery outpatient treated with SAFE anesthesia developing a deep venous thrombosis is approximately 0.5%. Additionally, ultrasound screening is an effective, feasible method for identifying affected patients for treatment. – by Jennifer Byrne

Disclosure: The Swanson reports no relevant disclosures.