The effect of postoperative enoxaparin on risk for reoperative hematoma

Christopher J. Pannucci, Christine Fisher Wachtman, George Dreszer, Steven H. Bailey, Pamela R. Portschy, Jennifer B. Hamill, Keith M. Hume, Ronald E. Hoxworth, Loree K. Kalliainen, J. Peter Rubin, Andrea L. Pusic, Edwin G. Wilkins

Research output: Contribution to journalArticle

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Abstract

BACKGROUND: The risk of postoperative bleeding is the chief concern expressed by plastic surgeons who do not use pharmacologic prophylaxis against venous thromboembolism. The Plastic Surgery Foundation-funded Venous Thromboembolism Prevention Study examined whether receipt of postoperative enoxaparin prophylaxis changed 60-day reoperative hematoma rates. METHODS: In 2009, the study's network sites uniformly adopted a "best practice" clinical protocol to provide postoperative enoxaparin to adult plastic surgery patients at risk for perioperative venous thromboembolism. Historical control patients (2006 to 2008) received no chemoprophylaxis for 60 days after surgery. Retrospective chart review identified demographic and surgery-specific risk factors that potentially contributed to bleeding risk. The primary study outcome was 60-day reoperative hematoma. Stratified analyses examined reoperative hematoma in the overall population and among high-risk patients. Multivariable logistic regression controlled for identified confounders. RESULTS: Complete data were available for 3681 patients (2114 controls and 1567 enoxaparin patients). Overall, postoperative enoxaparin did not change the reoperative hematoma rate when compared with controls (3.38 percent versus 2.65 percent, p = 0.169). Similar results were seen in subgroup analyses for breast reconstruction (5.25 percent versus 4.21 percent, p = 0.737), breast reduction (7.04 percent versus 8.29 percent, p = 0.194), and nonbreast plastic surgery (2.20 percent versus 1.46 percent, p = 0.465). In the regression model, independent predictors of reoperative hematoma included breast surgery, microsurgical procedure, and post-bariatric surgery body contouring. Receipt of postoperative enoxaparin was not an independent predictor (odds ratio, 1.16; 95 percent CI, 0.77 to 1.76). CONCLUSION: Postoperative enoxaparin does not produce a clinically relevant or statistically significant increase in observed rates of reoperative hematoma.

Original languageEnglish (US)
Pages (from-to)160-168
Number of pages9
JournalPlastic and Reconstructive Surgery
Volume129
Issue number1
DOIs
StatePublished - Jan 2012

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Enoxaparin
Hematoma
Venous Thromboembolism
Plastic Surgery
Breast
Hemorrhage
Bariatric Surgery
Mammaplasty
Chemoprevention
Clinical Protocols
Ambulatory Surgical Procedures
Practice Guidelines
Logistic Models
Odds Ratio
Demography
Outcome Assessment (Health Care)
Population

ASJC Scopus subject areas

  • Surgery

Cite this

Pannucci, C. J., Wachtman, C. F., Dreszer, G., Bailey, S. H., Portschy, P. R., Hamill, J. B., ... Wilkins, E. G. (2012). The effect of postoperative enoxaparin on risk for reoperative hematoma. Plastic and Reconstructive Surgery, 129(1), 160-168. https://doi.org/10.1097/PRS.0b013e318236215c

The effect of postoperative enoxaparin on risk for reoperative hematoma. / Pannucci, Christopher J.; Wachtman, Christine Fisher; Dreszer, George; Bailey, Steven H.; Portschy, Pamela R.; Hamill, Jennifer B.; Hume, Keith M.; Hoxworth, Ronald E.; Kalliainen, Loree K.; Rubin, J. Peter; Pusic, Andrea L.; Wilkins, Edwin G.

In: Plastic and Reconstructive Surgery, Vol. 129, No. 1, 01.2012, p. 160-168.

Research output: Contribution to journalArticle

Pannucci, CJ, Wachtman, CF, Dreszer, G, Bailey, SH, Portschy, PR, Hamill, JB, Hume, KM, Hoxworth, RE, Kalliainen, LK, Rubin, JP, Pusic, AL & Wilkins, EG 2012, 'The effect of postoperative enoxaparin on risk for reoperative hematoma', Plastic and Reconstructive Surgery, vol. 129, no. 1, pp. 160-168. https://doi.org/10.1097/PRS.0b013e318236215c
Pannucci CJ, Wachtman CF, Dreszer G, Bailey SH, Portschy PR, Hamill JB et al. The effect of postoperative enoxaparin on risk for reoperative hematoma. Plastic and Reconstructive Surgery. 2012 Jan;129(1):160-168. https://doi.org/10.1097/PRS.0b013e318236215c
Pannucci, Christopher J. ; Wachtman, Christine Fisher ; Dreszer, George ; Bailey, Steven H. ; Portschy, Pamela R. ; Hamill, Jennifer B. ; Hume, Keith M. ; Hoxworth, Ronald E. ; Kalliainen, Loree K. ; Rubin, J. Peter ; Pusic, Andrea L. ; Wilkins, Edwin G. / The effect of postoperative enoxaparin on risk for reoperative hematoma. In: Plastic and Reconstructive Surgery. 2012 ; Vol. 129, No. 1. pp. 160-168.
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AU - Hamill, Jennifer B.

AU - Hume, Keith M.

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AB - BACKGROUND: The risk of postoperative bleeding is the chief concern expressed by plastic surgeons who do not use pharmacologic prophylaxis against venous thromboembolism. The Plastic Surgery Foundation-funded Venous Thromboembolism Prevention Study examined whether receipt of postoperative enoxaparin prophylaxis changed 60-day reoperative hematoma rates. METHODS: In 2009, the study's network sites uniformly adopted a "best practice" clinical protocol to provide postoperative enoxaparin to adult plastic surgery patients at risk for perioperative venous thromboembolism. Historical control patients (2006 to 2008) received no chemoprophylaxis for 60 days after surgery. Retrospective chart review identified demographic and surgery-specific risk factors that potentially contributed to bleeding risk. The primary study outcome was 60-day reoperative hematoma. Stratified analyses examined reoperative hematoma in the overall population and among high-risk patients. Multivariable logistic regression controlled for identified confounders. RESULTS: Complete data were available for 3681 patients (2114 controls and 1567 enoxaparin patients). Overall, postoperative enoxaparin did not change the reoperative hematoma rate when compared with controls (3.38 percent versus 2.65 percent, p = 0.169). Similar results were seen in subgroup analyses for breast reconstruction (5.25 percent versus 4.21 percent, p = 0.737), breast reduction (7.04 percent versus 8.29 percent, p = 0.194), and nonbreast plastic surgery (2.20 percent versus 1.46 percent, p = 0.465). In the regression model, independent predictors of reoperative hematoma included breast surgery, microsurgical procedure, and post-bariatric surgery body contouring. Receipt of postoperative enoxaparin was not an independent predictor (odds ratio, 1.16; 95 percent CI, 0.77 to 1.76). CONCLUSION: Postoperative enoxaparin does not produce a clinically relevant or statistically significant increase in observed rates of reoperative hematoma.

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