Abdominoplasty Under Total Intravenous Anesthesia Significantly Decreases Deep Venous Thrombosis and Pulmonary Embolism Risk

Goals/Purpose: Deep venous thrombosis (DVT) and pulmonary embolism (PE) are the most

feared complications of abdominoplasty and multiple studies in the plastic surgery

literature have sought to prevent these complications. General anesthesia gasses are

known to cause vasodilatory effects that can promote venous stasis and increase the risk

of DVT. This study evaluates whether performing abdominoplasties under total

intravenous anesthesia (TIVA) instead of general anesthesia with anesthesia gasses can reduce the risk of DVT.

Methods/Technique: In this retrospective chart review, a single surgeon’s abdominoplasty cases

were evaluated for DVT incidence. Prior to 3/3/2004, all abdominoplasty cases were

performed under general anesthesia. After this point, all abdominoplasty cases were

performed in the outpatient setting at an American Association for Accreditation of

Ambulatory Surgery Facilities certified facility under TIVA. TIVA was performed by an

anesthesiologist with propofol, midazolam, fentanyl, and ketamine. Local anesthesia

with bupivacaine and tumescent solution with lidocaine was administered by the surgeon.

None of the patients in either group received chemoprophylaxis intraoperatively,

perioperatively, or postoperatively.

Results/Complications: 156 patients underwent abdominoplasty under general anesthesia from 1993-2004, 3 of which developed DVT and subsequent PE. 280 patients underwent abdominoplasty under TIVA from 2004-2021, 0 of which developed DVT/PE. Fischer exact test reveals the difference as statistically significant (p<0.05). No TIVA patients required emergent conversion to general anesthesia.

Conclusion: Performing abdominoplasty under TIVA greatly reduces the risk of DVT/PE, without the need for chemoprophylaxis and risks associated with it.