A Comprehensive Mechanical and Chemoprophylaxis Algorithm for Prevention of Venous Thromboembolism in Lipoabdominoplasty

Abstract Background Because the desire for body contouring rises exponentially, the rate of abdominoplasty continues to increase. Although this procedure provides patients with aesthetically pleasing results, pulmonary embolism (PE) represents a potentially fatal risk surgeons seek to avoid with risk stratification and prophylaxis based on the 2005 Caprini risk assessment model (RAM). Despite the efforts of the American Society of Plastic Surgery task force, much uncertainty exists on the appropriate venous thromboembolism (VTE) prophylaxis. Objectives The aim of this study is to demonstrate the safety and efficacy of utilizing a comprehensive mechanical and chemoprophylaxis protocol to prevent VTE in abdominoplasty. Methods This was a retrospective study reviewing 1 surgeon's (R.B.C.) postoperative complications for 333 patients who underwent abdominoplasty, belt lipectomy, or modified float tummy tuck from January 2017 to April 2024. All patients received chemoprophylaxis consisting of preoperative heparin injection, intraoperative intermittent pneumatic compression (IPC) devices, 1 week of postoperative enoxaparin injections and home IPCs for 2 weeks. All patients were preoperatively screened using the 2005 Caprini RAM; high-risk patients (≥6) continued enoxaparin injections for 1 month postoperatively. Results The median 2005 Caprini score was 4. There were 34 (10.2%) complications postoperatively: 2 (0.60%) PEs, 5 (1.50%) seromas, 6 (1.80%) hematomas, 3 (0.90%) wound healing complications, and 12 (3.60%) wound infections. The PE events occurred in patients with a 2005 Caprini score of 4. Conclusions The 2005 Caprini RAM provides a framework to guide VTE prophylaxis; however, patients with low/moderate-risk scores may suffer deep vein thrombosis (DVT) or PE. The authors demonstrate that a comprehensive mechanical and chemoprophylaxis protocol reduced the incidence of VTE compared with the literature and did not increase the risk of bleeding or complication. Level of Evidence: 3 (Therapeutic)