title: Venous Thromboembolism in the Cosmetic Patient: Analysis of 129,007 Patients.
abstract: Venous thromboembolism (VTE) is one of the most feared postoperative complications in cosmetic surgery. The true rate of VTE in this patient population remains largely unknown with current American Society of Plastic Surgeons (ASPS) prophylaxis recommendations partially extrapolated from other surgical specialties.
  
  
  
  This study analyzed the risk factors for VTE in cosmetic surgical procedures.
  
  
  
  A prospective cohort of patients who underwent aesthetic surgery between 2008 and 2013 was identified from the CosmetAssure database. Primary outcome was occurrence of a clinically significant VTE within 30 days of surgery. Risk factors analyzed included age, gender, body mass index (BMI), smoking, diabetes, type of surgical facility, procedure by body region, and combined procedures.
  
  
  
  A total of 129,007 patients were identified, of which 116 (0.09%) had a confirmed VTE. Combined procedures had a significantly higher overall rate of VTE compared to solitary procedures (0.20% vs 0.04%, P < .01). On multivariate logistic regression, significant risk factors for VTE (P < .05) included body procedures (RR 13.47), combined procedures (RR 2.4), increasing BMI (RR 1.06), and age (RR 1.02). Gender, smoking, diabetes, and type of surgical facility were not found to be significant risk factors. Face procedures (0.01%) and breast procedures (0.01%) had the lowest VTE rates, followed by combined face/body (0.16%), body procedures (0.21%), and combined body/breast procedures (0.28%).
  
  
  
  The incidence of VTE after cosmetic procedures is relatively low. However, the risk increases with combined procedures as well as with particular body areas, most notably trunk and extremities. Equally, significant patient risk factors exist, including BMI and age.
authors.affiliation: Department of Plastic Surgery, Vanderbilt University, Nashville, TN.
authors.forename: Julian
authors.initials: J
authors.lastname: Winocour
authors.affiliation: Department of Plastic Surgery, Vanderbilt University, Nashville, TN.
authors.forename: Varun
authors.initials: V
authors.lastname: Gupta
authors.affiliation: Department of Plastic Surgery, Vanderbilt University, Nashville, TN.
authors.forename: Christodoulos
authors.initials: C
authors.lastname: Kaoutzanis
authors.affiliation: Department of Plastic Surgery, Vanderbilt University, Nashville, TN.
authors.forename: Hanyuan
authors.initials: H
authors.lastname: Shi
authors.affiliation: Department of Plastic Surgery, Vanderbilt University, Nashville, TN.
authors.forename: R Bruce
authors.initials: RB
authors.lastname: Shack
authors.affiliation: Division of Plastic Surgery, University of Alabama at Birmingham, Birmingham, AL; and CME/MOC Section Editor for Aesthetic Surgery Journal.
authors.forename: James C
authors.initials: JC
authors.lastname: Grotting
authors.affiliation: Department of Plastic Surgery, Vanderbilt University, Nashville, TN.
authors.forename: K Kye
authors.initials: KK
authors.lastname: Higdon
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D002648:Child; D002675:Child, Preschool; D003357:Cosmetic Techniques / Q000009:adverse effects*; D016208:Databases, Factual; D004954:Esthetics; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D019651:Plastic Surgery Procedures / Q000009:adverse effects*; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D054556:Venous Thromboembolism / Q000175:diagnosis / Q000453:epidemiology*; D055815:Young Adult