Venous Thromboembolism After Abdominal Wall Reconstruction: A Prospective Analysis and Review of the Literature

Introduction: Ventral hernias are a common problem after exploratory laparotomy, and plastic surgeons often become involved for hernia repair in complex situations. Plastic surgeons can achieve fascial closure through primary repair, an external oblique aponeurosis release, or a transversus abdominis release. Currently, there is scant literature evaluating venous thromboembolism (VTE) rates after these procedures. We sought to evaluate our own experience with complex abdominal wall reconstruction and VTE events. Methods: We retrospectively reviewed our prospectively collected database of all patients who have undergone complex abdominal wall reconstruction by a single surgeon at our institution from September 2013 to February 2018. Demographic data, anticoagulant use, Caprini score, operative time, and post-operative VTE events were recorded. A literature search was also performed, identifying all published articles evaluating VTE events after abdominal wall reconstruction Results: We identified 175 patients for analysis. Four patients were found to have post-operative VTE events, for a total VTE rate of 2.3%. The average Caprini score for these patients was 8.5, compared to 5.26 for those without a VTE event, and no deaths were reported from these complications. On literature review, three papers were identified in the literature discussing VTE after abdominal wall reconstruction, all based on the ACS-NSQIP database. Conclusion: Patients undergoing complex abdominal wall reconstruction are at high risk for VTE events. There is scant literature published on this topic, but surgeons should be aware of the risk for VTE after complex abdominal wall reconstruction and work to minimize this risk as much as able. Financial Disclosure Statement: Dr. Janis has served as a prior consultant for LifeCell, Bard, Pacira, and Allergan greater than 12 months ago, but has no current active affiliations. He receives royalties from Thieme Publishing. The remaining authors have no conflicts of interest to disclose. No funding was received for this research. Corresponding author: Jeffrey E. Janis, MD, FACS, Professor of Plastic Surgery, Neurosurgery, Neurology, and Surgery, Department of Plastic Surgery, The Ohio State University Wexner Medical Center, 915 Olentangy River Road, Suite 2100, Columbus, OH 43212, USA. Phone: (614) 293-8566, Fax: (614) 293-9024, E-mail: Jeffrey.Janis@osumc.edu ©2019American Society of Plastic Surgeons

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