Rectus Plication Does Not Increase Risk of Thromboembolic Events Following Abdominal Body Contouring: A Matched Case-Control Analysis

Background: Rectus abdominis plication increases intra-Abdominal pressure and lower-extremity venous stasis, which may increase the incidence of venous thromboembolism (VTE) events. Objectives: The aim of this study was to investigate the potential association between VTE and rectus abdominis muscle plication during surgery. Methods: A retrospective review of all patients who underwent abdominal body contouring at the authors' institution between 2010 and 2020 was completed. Cases were those with postoperative VTEs and were matched to controls (1:4) via potential confounders. Variables collected include demographic data, operative details, comorbidities, and postoperative complications. Statistical analysis was performed with parametric, nonparametric, and multivariable regression modeling. Results: Overall, 1198 patients were included; 19 (1.59%) experienced a postoperative VTE and were matched to 76 controls. The overall cohort was 92.7% female with an average age of 44 years, an average Charlson Comorbidity Index of 1 point, and an average BMI of 30.1 kg/m2. History of cerebrovascular events (14.5% vs 36.8%, P=0.026) differed significantly between cohorts, but no significant associations were noted in all other baseline demographics. Additionally, VTE cases were more likely to have received intraoperative blood transfusions (odds ratio=8.4, P=0.04). Bivariate analysis demonstrated cases were significantly more likely to experience concurrent complications, including delayed wound healing (0% vs 5.3%, P=0.044), seroma formation (5.3% vs 21.1%, P=0.027), and fat necrosis (0% vs 5.3%, P=0.044). However, these findings were not significant in a multivariable regression model. Plication was not associated with VTE outcomes. Conclusions: Rectus plication does not increase the risk of VTE. However, the odds of VTE are significantly increased in patients who received intraoperative blood products compared with those who did not.