Incidence of Post Operative VTE following Panniculectomy in Patients with History of COVID-19

SDCC 

Purpose: Venous thromboembolism (VTE) is well-documented post operative complication with potentially life-threatening sequelae.[1] While the risk of VTE in plastic surgery patients is low, these devastating consequences pose a critical need for assessment of risk factors.[2] Recent research has elucidated that a history of COVID-19 infection may be an additional predisposing risk factor to VTE formation. [3,4] Therefore our study aims to assess the risk of VTE in panniculectomy patients with the history of COVID-19.

Methods: The TriNetX LLC. National Health Research database was queried to identify patients who underwent panniculectomy in the years 2017-2020 (pre-pandemic) and 2020-2023 (post-pandemic). In addition, post-pandemic patients were further studied by querying the data to look for those with a history of COVID versus those without. These cohorts were analyzed to calculate the incidence rate of VTE in the 30 days post operative period.

Results: A total cohort of 7,114 patients who underwent panniculectomy on prophylactic anticoagulation were identified. There were 3,015 patients in the pre-pandemic and 4,099 patients in the post-pandemic group. In the post-pandemic group, there were 790 patients with a prior history of COVID and 3,309 patients without. The rate of VTE was not significantly different in the pre (3.2%) versus post (3.0%) pandemic cohorts (p=0.64). However, in the post-pandemic cohort, there was a significant difference in VTE rates between patients with (4.9%) and without (2.5%) prior history of COVID (p= 0.0002).

Conclusion: Our study showed there was no significant increase in VTE incidence after panniculectomy during the pandemic. However, patients with a history of COVID may be more susceptible to postoperative VTEs as its true long term morbid effects are yet to be fully understood. Therefore, history of COVID should be carefully considered when determining a patient's VTE risk and warrants further study for optimal perioperative and postoperative anticoagulation strategies.

References:
1. Young, V., Watson, M., 2006. Continuing medical education article-patient safety: The need for venous thromboembolism (VTE) prophylaxis in plastic surgery. Aesthetic Surgery Journal 26, 157–175. https://doi.org/10.1016/j.asj.2006.02.001
2. Kalmar, C. , Thayer, W. , Kassis, S. , Higdon, K. & Perdikis, G. (2022). Pulmonary Embolism Risk After Cosmetic Abdominoplasty and Functional Panniculectomy. Annals of Plastic Surgery, 89 (6), 664-669. doi: 10.1097/SAP.0000000000003281.
3. Executive Council of ASMBS. Safer through surgery: American Society for Metabolic and Bariatric Surgery statement regarding metabolic and bariatric surgery during the COVID-19 pandemic. Surg Obes Relat Dis. 2020 Aug;16(8):981-982. doi: 10.1016/j.soard.2020.06.003. Epub 2020 Jun 6. PMID: 32565394; PMCID: PMC7274951.
4. Bunch CM, Moore EE, Moore HB, Neal MD, Thomas AV, Zackariya N, Zhao J, Zackariya S, Brenner TJ, Berquist M, Buckner H, Wiarda G, Fulkerson D, Huff W, Kwaan HC, Lankowicz G, Laubscher GJ, Lourens PJ, Pretorius E, Kotze MJ, Moolla MS, Sithole S, Maponga TG, Kell DB, Fox MD, Gillespie L, Khan RZ, Mamczak CN, March R, Macias R, Bull BS, Walsh MM. Immuno-Thrombotic Complications of COVID-19: Implications for Timing of Surgery and Anticoagulation. Front Surg. 2022 May 4;9:889999. doi: 10.3389/fsurg.2022.889999. PMID: 35599794; PMCID: PMC9119324.

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