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

Background: Venous thromboembolism (VTE) is the most feared complications of abdominoplasty, and multiple studies in the plastic surgery literature have sought to prevent these complications. General inhalational anesthesia can increase the risk of VTE via a variety of mechanisms. This study evaluates whether performing abdominoplasties under total intravenous anesthesia (TIVA) instead of general inhalational anesthesia can reduce the risk of VTE.

Methods: In this retrospective chart review, a single surgeon's abdominoplasty cases were evaluated for VTE incidence. Prior to 3/3/2004, all abdominoplasty cases were performed under general inhalational 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: A total of 156 patients underwent abdominoplasty under general anesthesia from 1993 to 2004, 3 of which developed VTE; 280 patients underwent abdominoplasty under TIVA from 2004 to 2021, 0 of which developed VTE. 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 VTE, without the need for chemoprophylaxis and risks associated with it.

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