National Mortality Rates after Outpatient Cosmetic Surgery and Low Rates of Perioperative Deep Vein Thrombosis Screening and Prophylaxis

Bucknor, Alexandra; Egeler, Sabine A.; Chen, Austin D.; Chattha, Anmol; Kamali, Parisa; Brownstein, Gary M.; Reed, Lawrence S.; Watts, David M.; Lin, Samuel J.

doi:10.1097/prs.0000000000004499

Cited by 17 publications

(8 citation statements)

References 12 publications

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“…28 To reduce mortality, the necessity of early recognition, vigorous fluid resuscitation, and radical surgical débridement has been pointed out by numerous studies. 29 In keeping with previous study, 30 results from our study indicated that VTE events are the identified cause of mortality in patients following body contouring. Consequently, careful documentation of hematoma severity, consistent assessment of VTE risk (ie, Caprini score), and standardized VTE chemoprophylaxis protocols are essential.…”

Section: Discussionsupporting

confidence: 91%

Machine learning prediction algorithm for in-hospital mortality following body contouring

Peng

Yang

et al. 2023

Plastic &Amp; Reconstructive Surgery

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besity is currently a global epidemic; worldwide, 1.9 billion people older than 18 years are overweight. Of these, over 650 million are obese. 1 Indeed, with the increasing prevalence of obesity in the population, in conjunction with the rising number of bariatric operations, there is a mounting emphasis on the surgical treatment of residual contour deformities after weight loss, frequently in the form of body contouring. 2 Postbariatric contouring procedures last year alone accounted of more than 46,577 procedures. 3 Indeed, it is well-known that body contouring can cause an improvement in the health; mobility; and self-esteem, especially increased satisfaction with body figure. 4 However, despite growing popularity and potential benefits, the safety of the body-contouring procedure has been a subject of Background: Body contouring is a common procedure, but it is worth attention because of concern for a variety of complications, and even the potential for death. As a result, the purpose of this study was to determine the key predictors following body contouring and create models for the risk of mortality using diverse machine learning (ML) models. Methods: The National Inpatient Sample database from 2015 to 2017 was queried to identify patients undergoing body contouring. Candidate predictors, such as demographics, comorbidities, personal history, postoperative complications, and operative features, were included. The outcome was inhospital mortality. Models were compared by area under the curve, accuracy, sensitivity, specificity, positive and negative predictive values, and decision curve analysis. Results: Overall, 8214 patients undergoing body contouring were identified, among whom 141 (1.72%) died in the hospital. Variable importance plot demonstrated that sepsis was the variable with greatest importance across all ML algorithms, followed by Elixhauser Comorbidity Index, cardiac arrest, and so forth. The naive Bayes model had a higher predictive performance (area under the curve, 0.898; 95% CI, 0.884 to 0.911) among these eight ML models. Similarly, in the decision curve analysis, the naive Bayes model also demonstrated a higher net benefit (ie, the correct classification of in-hospital deaths considering a tradeoff between false-negatives and false-positives) compared with the other seven models across a range of threshold probability values. Conclusion:The ML models, as indicated by this study, can be used to predict in-hospital death for patients at risk who undergo body contouring. (Plast.

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Section: Discussionsupporting

confidence: 91%

Machine learning prediction algorithm for in-hospital mortality following body contouring

Peng

Yang

et al. 2023

Plastic &Amp; Reconstructive Surgery

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“…[16][17][18] Even though cosmetic surgery patients are often healthy and do not carry multiple risk factors for VTE, it accounts for more deaths among patients undergoing cosmetic surgery than any other cause. 19 In 2012, a task force of the American Society of Plastic Surgeons established guidelines on the assessment and prophylaxis of venous thromboembolism, which is based on the 2005 Caprini risk assessment module. 5,20 However, unknown or undiagnosed disorders as well as gene mutations are not included.…”

Section: Discussionmentioning

confidence: 99%

Undiagnosed Patent Foramen Ovale and Thrombophilic Gene Mutations Resulting in Pulmonary Embolism with Cryptogenic Stroke after Cosmetic Breast Surgery

Zaussinger

Speiser

Wenny

et al. 2023

Plastic and Reconstructive Surgery - Global Open

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Undiagnosed disorders or gene mutations can lead to life-threatening events even in cosmetic surgery. Herein, the authors present a case of a young and supposedly healthy 36-year-old woman who survived an episode of bilateral pulmonary embolism and cryptogenic stroke after cosmetic breast augmentation-mastopexy. Two days after cosmetic surgery, the patient presented at the emergency stroke unit after she collapsed at home, following frequent generalized seizures. After she was transferred to the intensive care unit, it was revealed that the patient had an undiagnosed patent foramen ovale and several thrombophilic gene mutations. During the stay, two episodes of active bleeding and beginning nipple-areola complex hypoperfusion led to bilateral implant removal. As a final result, the patient lost her breast implants and experienced persistent hypoesthesia of the entire left hemi body. However, this case might highlight deficits in current venous thromboembolism risk assessment and prophylaxis due to the missing considerations of undiagnosed disorders or gene mutations. Further, recommendations on dealing with implants or aesthetic outcome in crucial episodes should be introduced.

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Section: Discussionmentioning

confidence: 99%

“…Notably, a 2018 white paper issued by the American Association for Accreditation of Ambulatory Surgery Facilities highlighted the importance of venous thromboembolism risk factor assessment for patients undergoing outpatient surgery. 30 Scarce case reports and review literature suggest that the incidence of DVT after forearm, wrist, and hand surgery is very low (LOE: IV, IV, III). [31][32][33] Chemical prophylaxis risks wound complications and likely only provides an improvement in DVT rates for high risk surgical cases.…”

Section: Smentioning

confidence: 99%

A 15-Year Review of Clinical Practice Patterns and Evidence-Based Medicine in Carpometacarpal Joint Arthroplasty

Shah

Yuksel

Sasson

et al. 2021

Hand (New York, N,Y.)

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Background: The purpose of this study was to help understand national practice patterns in carpometacarpal (CMC) arthroplasty and how they have evolved with evidence-based recommendations over the past 15 years. Methods: The American Board of Plastic Surgery (ABPS) started collecting practice data on primary CMC joint arthroplasty in 2006 as a portion of its continuous certification (CC) process. Data on primary CMC arthroplasty from May 2006 through December 2013 were reviewed and compared to those from January 2014 to March 2020. National practice trends observed in these data were evaluated. Comprehensive evidence-based medicine reviews published in 2008, 2011, 2013, and 2017 were reviewed alongside the CC data. Results: In all, 570 primary CMC joint arthroplasty cases were included from May 2006 to March 2020. The average age at the time of repair was 62 years and the patient population was predominantly female (79%). Most cases were done under general anesthesia (69%), and there was an increase in the use of regional anesthesia with nerve block when our 2 cohorts were compared (27% vs 37%; P = .020). A trapezium excision with flexor carpi radialis tendon ligament reconstruction was the most popular technique (72%) and an increase in the use of simple trapeziectomy was observed (6% vs 14%; P = .001). One-third of patients did not receive any form of deep vein thrombosis prophylaxis. Conclusions: The ABPS CC data provide a databank that allows for direct observation of national practice trends and sheds light on potential avenues for improvement in patient care.

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National Mortality Rates after Outpatient Cosmetic Surgery and Low Rates of Perioperative Deep Vein Thrombosis Screening and Prophylaxis

Cited by 17 publications

References 12 publications

Machine learning prediction algorithm for in-hospital mortality following body contouring

Machine learning prediction algorithm for in-hospital mortality following body contouring

Undiagnosed Patent Foramen Ovale and Thrombophilic Gene Mutations Resulting in Pulmonary Embolism with Cryptogenic Stroke after Cosmetic Breast Surgery

A 15-Year Review of Clinical Practice Patterns and Evidence-Based Medicine in Carpometacarpal Joint Arthroplasty

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