Venous Thromboembolism and Bleeding Events With Chemoprophylaxis in Abdominoplasty: A Systematic Review and Pooled Analysis of 1,596 Patients.

BACKGROUND Many plastic surgeons avoid the administration of venous thromboembolism (VTE) chemoprophylaxis out of concern for surgical bleeding in abdominoplasty. While previous studies have attempted to address the relationship between abdominoplasty and bleeding or VTE, poor reporting techniques remain a challenge. As a result, there has been a lack of reliable data to guide clinical practice. OBJECTIVES To determine the prevalence of bleeding and VTE in abdominoplasty with and without chemoprophylaxis. METHODS A systematic review was performed following PRISMA guidelines using PubMed, CINAHL and Cochrane Central. Patient demographics, comorbidities, risk category (if available), bleeding events, VTE events, and chemoprophylaxis information were recorded. RESULTS Across 10 articles, 691 patients received chemoprophylaxis in the setting of abdominoplasty: 68 preoperatively, 588 postoperatively, and 35 received both. 905 patients did not receive chemoprophylaxis. 96.8% of patients were female, 73% underwent concomitant liposuction, and none were clearly risk stratified. The overall incidence of VTE and bleeding was 0.56% (9/1596) and 1.6% (25/1596), respectively. Compared to no chemoprophylaxis, chemoprophylaxis was not associated with increased incidence of bleeding [1.3% (9/671) vs. 0.91% (8/881), p=0.417], nor with decreased incidence of VTE [0.87% (6/691) vs. 0.33% (3/901), p = 0.187]. CONCLUSION The prevalence of bleeding in abdominoplasty was low. Chemoprophylaxis was not associated with increased risk of bleeding or decreased risk of VTE, though the lack of risk stratification and heterogeneity of our cohort precludes firm conclusions regarding the benefits and/or risks of chemoprophylaxis. Our study underscores the importance of utilizing validated risk-stratification tools in order to guide perioperative decision making.