An In-Depth Analysis of 1370 Consecutive Abdominoplasties: Fascial Plication Increases Risk of Venous Thromboembolism, and Scoring for Plication Improves the Caprini Risk Assessment Model

Abstract Background Venous thromboembolism (VTE) is the most dangerous complication of abdominoplasty. One relatively undefined risk factor is plication, which in theory increases VTE risk. Objectives The aim of this study was to assess the thromboembolic risk of plication. Methods A retrospective review of 1370 consecutive abdominoplasties by 1 surgeon was undertaken. Two groups were considered, plicated (n = 1089) and nonplicated (n = 281) patients, and VTE rates were compared between these groups. Results There were 25 of 1089 cases of VTE (2.3%) in plicated patients and 1 of 281 cases of VTE (0.36%) in nonplicated patients, which was statistically significant (Fisher's exact test, P = .028) despite the nonplicated group being a higher-risk population. Case-control matching yielded 225 pairs which differed statistically only by the presence or absence of plication; there were 12 of 225 (5.3%) VTE events in the plicated group and 0 of 225 in the nonplicated group (McNemar's test, P = .0015). Logistic regression demonstrated increased VTE risk with increasing age (odds ratio [OR] 1.08, P < .001), BMI (OR 1.34, P = .002), Caprini score (OR 2.17, P < .001), and especially plication (OR 16.76, P = .008). Adding 2 points for plication to Caprini scores offered better risk stratification at a level of 7, with an improved combination of sensitivity and specificity (0.31/0.98 vs 0.69/0.96) and a 27% improvement over the 2005 Caprini risk assessment model (RAM) in the area under a receiver operating characteristic curve (0.826 vs 0.651, Z value −3.596, P = .003). Conclusions Plication was shown to be a powerful risk factor for the development of VTE in abdominoplasty. Abdominal wall plication should be considered in risk assessment, and scoring for plication may improve the performance of the Caprini RAM. Level of Evidence: 3