title: Risk of adverse outcomes when plastic surgery procedures are combined.
abstract: BACKGROUND
  The ability to study population-level outcomes of outpatient cosmetic procedures has been limited by a lack of longitudinal data. This study aimed to describe the rates of adverse events in patients who underwent an isolated cosmetic surgery procedure compared with those who had a combination of two procedures.
  
  
  METHODS
  Retrospective longitudinal analysis was performed of the 2005 to 2010 California Office of Statewide Health Planning and Development Ambulatory Surgery Database. Patients were included if they had undergone an abdominoplasty or any other procedure that was identified as frequently performed concurrently with abdominoplasty. Patients' subsequent in-patient admissions and emergency department visits were identified. Outcomes analyzed were the 30-day and 1-year venous thromboembolism rates, 30-day hospital admission rate, 30-day emergency department visit rate, and 30-day mortality rate.
  
  
  RESULTS
  A total of 477,741 patients were analyzed, of whom 16,893 had undergone two concurrent procedures. The 12-month venous thromboembolism rate was 0.57 percent for patients undergoing abdominoplasty, 0.20 percent for liposuction, 0.12 percent for breast procedures, 0.32 percent for hernia repair, 0.28 percent for face procedures, and 0.28 percent for thigh lift/brachioplasty. Greater than additive 30-day and 1-year venous thromboembolism rates were observed among patients who underwent an abdominoplasty and liposuction (0.68 percent and 0.81 percent, respectively) and those who underwent an abdominoplasty and hernia repair (0.93 percent).
  
  
  CONCLUSIONS
  Some combinations of elective outpatient procedures conferred an additive, and sometimes more than additive, venous thromboembolism risk. This is an important consideration when informing patients of potential postoperative complications and for venous thromboembolism prophylaxis.
authors.affiliation: San Diego, Calif. From the Division of Plastic Surgery and the Department of Surgery, University of California, San Diego.
authors.forename: Ahmad N
authors.initials: AN
authors.lastname: Saad
authors.forename: Ralitza
authors.initials: R
authors.lastname: Parina
authors.forename: David
authors.initials: D
authors.lastname: Chang
authors.forename: Amanda A
authors.initials: AA
authors.lastname: Gosman
mesh_terms: D000328:Adult; D000368:Aged; D003357:Cosmetic Techniques; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology*; D019651:Plastic Surgery Procedures; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors