open3openTanzillo, Giuseppe; Vindigni, Vincenzo; Bassetto, FrancoTanzillo, Giuseppe; Vindigni, Vincenzo; Bassetto, Franc

Bassetto, Franco

Tanzillo, Giuseppe

Vindigni, Vincenzo

Plastic & Reconstructive Surgery Global Open

English

PubMed

TANZILLO, GIUSEPPE

VINDIGNI, VINCENZO

BASSETTO, FRANCO

Archivio istituzionale della ricerca - Università di Padova

	 www.PRSGlobalOpen.com	 1BACKGROUNDThromboembolism is a postoperative complica-tion that ought to be avoided because of its high risk of mortality. Thromoembolism prevention guidelines are subject to the outcome of yearly international consensus conferences.1 In the field of plastic surgery, the patients at increased risk of pulmonary thromboembolism or deep vein thrombosis (DVT) are the patients who are most debilitated (burned), patients subjected to long periods of bed rest, and those undergoing post-bariatric surgery.2,3METHODSBetween 2005 and 2015, among 22,765 who had undergone “major” plastic surgery, 936 patients with weight loss (4.1%) had been subjected to postbariat-ric surgery with general anesthesia lasting for more than 1 hour. All patients had undergone thrombo-embolic prophylaxis with low molecular weight hep-arin and other preventive measures such as elastic compression and progressive and early mobilization postoperatively, especially when they were expected to have more than 3 days of bed rest.RESULTSNineteen of 22,765 (0.083%) patients developed thromboembolic phenomena; among the  patients who had taken preventive measures, 8 of 19 had been subjected to postbariatric surgery. Thirteen of 19 patients showed complications after discharge (Fig. 1A). According to data analysis and based on a large number of clinical cases (Fig. 1B), we estimat-ed that the risk of thromboembolic complications is >10 times  higher in patients  undergoing postbar-iatric surgery than in high-risk patients undergoing a major surgery with general anesthesia lasting for more than 1 hour.CONCLUSIONSThe routine use of low molecular weight heparin, the use of elastic compression intraoperatively and postoperatively, and early mobilization associated with physiotherapy have allowed us to minimize the occurrence of DVT and pulmonary thromboembo-lism during hospitalization, according to data from international literature.4,5 Obese patients with weight loss need a specific treatment approach and preop-erative preparation, which includes paying attention to risk factors2,6 associated with thromboembolism, namely, male sex, age >60 years, smoking, previous history of DVT, and history of chronic inflamma-tory diseases/thrombophilia or neoplastic disease.7,8 We need to stratify the risk for each patient, and for those patients with more predisposing factors, we need to pay close attention to the duration of pro-phylaxis and hospitalization, following updated in-ternational guidelines.The Assessment of Thromboembolism Risk in Postbariatric Patient: Our Experience in  936 PatientsGiuseppe Tanzillo, MDVincenzo Vindigni, MD, PhDFranco Bassetto, MD SICPRE: La SICPRE, Società Italiana di Chirurgia Plastica Ricostruttiva ed Estetica, national meeting, in Milano, Italy on September 17–19, 2015.Copyright © 2016 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The American Society of Plastic Surgeons. All rights reserved. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially.Plast Reconstr Surg Glob Open 2016;4:e650; doi:10.1097/GOX.0000000000000639; Published online 18 March 2016.From the Clinic of Plastic and Reconstructive Surgery, Department of Neurosciences, University of Padua, Padua, Italy.Presented at the 64th Annual Meeting of the SICPRE, September 17–19, 2015, Milan, Italy.Meeting Proceedings 2015 SICPRE Congress Young Plastic Surgeon Best Abstracts2PRS Global Open • 2016Giuseppe TanzilloClinica di Chirurgia Plastica Azienda Ospedaliera di Padova, Via Giustiniani 2 – 35128, Padua, Italy E-mail: giuseppe.tanzillo@hotmail.comREFERENCES 1. Tietze M, Gurley J. VTE prevention: development of an institutional protocol and the nurse’s role. Medsurg Nurs. 2014;23:331–333, 342. 2. Bartlett MA, Mauck KF, Daniels PR. Prevention of venous thromboembolism in patients undergoing bariatric sur-gery. Vasc Health Risk Manag. 2015;11:461–477. 3. Griffin M, Akhavani MA, Muirhead N, et al. Risk of throm-boembolism following body-contouring surgery after mas-sive weight loss. Eplasty 2015;15:e17. 4. Iorio ML, Venturi ML, Davison SP. Practical guidelines for venous thromboembolism chemoprophylaxis in elective plastic surgery. Plast Reconstr Surg. 2015;135:413–423. 5. McRae S. Treatment options for venous thromboembo-lism: lessons learnt from clinical trials. Thromb J. 2014;12:27. 6. Cukic V, Baljic R. The most common detected risk and etiologic factors of pulmonary thromboembolism. Mater Sociomed. 2012;24:223–226. 7. Lee AY. Prevention and treatment of venous thromboem-bolism in patients with cancer. Hematology Am Soc Hematol Educ Program. 2014;2014:312–317. 8. Epaulard O, Foote A, Bosson JL. Chronic infection and venous thromboembolic disease. Semin Thromb Hemost. 2015;41:644–649.Disclosure: The authors have no financial interest to declare in relation to the content of this article. The  Article Processing Charge was supported by a grant of Egle Muti MD, in memory of Professor Aldo Fontana, MD.Fig. 1. A, this diagram illustrates that the majority of cases occurred after discharge, partic-ularly in 8 patients discharged after postbariatric surgery. B, computed tomography angi-ography shows severe bilateral pulmonary thrombosis of a patient who underwent (4-hour general anesthesia) combined postbariatric surgery (breast and lower-limb lift).

The Assessment of Thromboembolism Risk in Postbariatric Patient: Our Experience in 936 Patients

Giuseppe Tanzillo

Vincenzo Vindigni

Franco Bassetto

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The Assessment of Thromboembolism Risk in Postbariatric Patient

Padua Research Archive

http://dx.doi.org/10.1097/GOX.0000000000000639

The Assessment of Thromboembolism Risk in Postbariatric Patient: Our Experience in 936 Patients

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