Introduction:
The PSEF-funded Venous Thromboembolism Prevention (VTEP) study is evaluating the efficacy of post-operative LMWH for venous thromboembolism (VTE) prevention in plastic surgery patients. In preliminary analysis of the VTEP database, we evaluated rates of operative hematoma formation when post-operative LMWH is and is not used. Additionally, we examined the relationship between procedure type and hematoma formation in patients not receiving LMWH prophylaxis.
Methods:
In June 2008, each institution implemented a clinical protocol for VTE prophylaxis, which included pre-operative risk stratification and post-operative LMWH. The control group did not receive LMWH. Chart reviews identified thromboembolic and bleeding complications for 60 days post-operatively. We examined rates of post-operative hematoma, stratified by receipt of LMWH and procedure type.
Results:
Our mid-term analysis of the database identified 325 patients who received post-operative LMWH and 941 patients who did not. The hematoma rate requiring surgical drainage, irrespective of procedure, showed no significant difference (p=0.78) between patients who received post-operative LMWH (2.40%) and those who did not (2.69%). Among patients not receiving LMWH, those having breast surgery were at disproportionate risk for hematoma development. Breast reduction patients comprised 4% of the dataset but represented 23% of patients with post-operative hematomas. Similar trends were seen for breast reconstruction and cosmetic breast surgery.
Conclusion:
In this mid-term analysis of VTEP data, post-operative LMWH did not significantly affect overall post-operative hematoma rates. In patients not receiving LMWH, breast surgery patients were at disproportionately increased risk for re-operative hematomas. At this time the number of patients is not adequate to evaluate whether decisions regarding VTE prophylaxis should consider procedure type.