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patients with Caprini scores of ≥7: “Should consider utilizing risk reduction strategies such as limiting OR times, weight reduction, discontinuing hormone replacement therapy and early postoperative mobilization.” 3. For body contouring or abdominoplasty under general anesthesia with procedure time >60 minutes: a. Caprini score 3-6: “Should consider the option to use postoperative low molecular weight heparin or unfractionated heparin.” b. Caprini score ≥ 3: “Should consider the option to utilize mechanical prophylaxis…for non-ambulatory patients.” c. Caprini score ≥ 7: “Should strongly consider the option to use extended [duration] low molecular weight heparin postoperative prophylaxis.” American Association of Plastic Surgeons Consensus Panel (2016)7 1. “We recommend using non-general anesthesia when appropriate. When possible, consideration should be given to using monitored anesthesia care, local anesthesia with sedation, or neuraxial anesthesia instead of general anesthesia.” 2. “We recommend using intermittent pneumatic compression to prevent perioperative venous thromboembolism events in plastic surgery patients…intermittent pneumatic compression is superior to elastic compression stockings.” 3. “We recommend all plastic and reconstructive surgery patients should be risk-stratified for perioperative venous thromboembolism risk using a 2005 Caprini score.” 4. “We do not recommend adding chemoprophylaxis to intermittent pneumatic compression for venous thromboembolism prophylaxis in the general non-risk stratified plastic surgery population.” 5. “We recommend that surgeons consider chemoprophylaxis on a case-by-case basis in patients with Caprini score greater than 8.” 6. “We do not recommend adding routine chemoprophylaxis for venous thromboembolism prophylaxis in nonrisk stratified patients undergoing…body contouring.” CONCLUSIONS Venous thromboembolism is a rare but potentially life- or limb-threatening complication of ambulatory and aesthetic surgery. This review article has outlined the central tenets of VTE risk stratification and VTE risk modification. At present, all VTE events in surgical patients cannot be prevented. VTE risk can be considered and actively Downloaded from https://academic.oup.com/asj/article-abstract/39/2/209/5017390 by guest on 20 February 2020 Pannucci 217 modified in the preoperative, intraoperative, and postoperative considerations to minimize, but not eliminate, risk for VTE. Disclosures Dr Pannucci receives salary and research support from the American Association of Plastic Surgeons/Plastic Surgery Foundation Academic Scholar Program. Funding The author received no financial support for the research, authorship, and publication of this article. REFERENCES 1. Office of the Surgeon General; National Heart, Lung, and Blood Institute. The Surgeon General’s Call to Action to Prevent Deep Vein Thrombosis and Pulmonary Embolism. Rockville, MD: Office of the Surgeon General; 2008. http://www.surgeongeneral.gov/library/calls/index. html. Accessed April 12, 2018. 2. Pannucci CJ, Dreszer G, Wachtman CF, et al. Postoperative enoxaparin prevents symptomatic venous thromboembolism in high-risk plastic surgery patients. Plast Reconstr Surg. 2011;128(5):1093-1103. 3. Pannucci CJ, Bailey SH, Dreszer G, et al. Validation of the Caprini risk assessment model in plastic and reconstructive surgery patients. J Am Coll Surg. 2011;212(1):105-112. 4. Pannucci CJ, Wachtman CF, Dreszer G, et al. The effect of postoperative enoxaparin on risk for reoperative hematoma. Plast Reconstr Surg. 2012;129(1):160-168. 5. Pannucci CJ, Rockwell WB, Ghanem M, Fleming KI, Momeni A, Agarwal J. Inadequate enoxaparin dosing predicts 90-day venous thromboembolism risk among plastic surgery inpatients: an examination of enoxaparin pharmacodynamics. Plast Reconstr Surg. 2017;139(4):1009-1020. 6. Evidence-based practices for thromboembolism prevention: a report from the ASPS Venous Thromboembolism Task Force. https://www.plasticsurgery.org/for-medicalprofessionals/quality-and-registries/venous-thromboembolism-awareness-campaignMurphy; 2011. Accessed April 12, 2018. 7. Pannucci CJ, MacDonald JK, Ariyan S, et al. Benefits and risks of prophylaxis for deep venous thrombosis and pulmonary embolus in plastic surgery: a systematic review and meta-analysis of controlled trials and consensus conference. Plast Reconstr Surg. 2016;137(2):709-730. 8. American Society for Aesthetic Plastic Surgery. Common sense guide to venous thromboembolism prevention in aesthetic surgery. https://www.surgery.org/professionals/ patient-safety/safety-protocols. Accessed April 12, 2018. 9. Heit JA, Silverstein MD, Mohr DN, Petterson TM, O’Fallon WM, Melton LJ 3rd. Predictors of survival after deep vein thrombosis and pulmonary embolism: a population-based, cohort study. Arch Intern Med. 1999;159(5):445-453. 10. Heit JA. The epidemiology of venous thromboembolism in the community: implications for prevention and management. J Thromb Thrombolysis. 2006;21(1):23-29. 11. Kearon C. Natural history of venous thromboembolism. Circulation. 2003;107(23 Suppl 1):I22-I30. 12. Kahn SR, Shbaklo H, Lamping DL, et al. Determinants of health-related quality of life during the 2
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