Embolism and Surgery
New York, NY -- Background: Deep vein thrombosis (DVT), pulmonary embolism (PE), and fat embolism syndrome (FES) are risks associated with surgery but not confined to surgical patients. DVT may be present in medical patients confined to bed rest for a significant period or to others during times of immobilization such as lengthy air travel. The most common risk factors for DVT and PE are: a previous history of the conditions, recent surgery or pregnancy, prolonged immobilization or bed rest, obesity, varicose veins, oral contraceptives or underlying malignancy. In the United States, PE is the third most common cause of death in all age groups, with at least 650,000 cases occurring annually. Women are generally more susceptible than men, and PE is the most frequent cause of death associated with childbirth. Because PE often causes only vague and nonspecific symptoms, diagnosis is often missed.
Deep Vein Thrombosis (DVT) -- Blood clots that develop within veins.
Pulmonary Embolism (PE) -- Blood clots within veins break off and are trapped in the lungs.
Fat Embolism (FES) -- A fat globule gets into the bloodstream.
Pulmonary Fat Embolism (PFES) – a fat globule gets trapped in the lungs.
Considerations: Like all surgery, cosmetic surgery carries some risk of DVT, PE, FES, and PFES. Such complications are unpredictable and can occur after a facelift, breast surgery, tummy tuck, lipoplasty (liposuction) or any other elective or nonelective surgical procedure.
Prevention/Treatment: Measures can be taken to minimize risk for surgical patients. These may include the use of pneumatic compression devices (foot, knee-high or thigh-high pumps), compression stockings, and medications such as low molecular weight heparin. Other strategies include careful patient selection, limiting the number/length of procedures in the same operating session, and vigilant postoperative assessment.
ASAPS' Position: All elective surgery patients should be thoroughly informed of the risks of surgery, including the risks of DVT, PE, FES, and PFES, and weigh these risks against the potential benefits of the surgical procedure. Because some cosmetic surgery patients may be at higher risk than others, patients must be candid with their plastic surgeon in discussing underlying medical conditions and all medications. While not all complications of surgery are preventable, American Board of Plastic Surgery certified surgeons are fully trained to handle emergencies that may occur during surgery or in the postoperative period. In addition, accredited ambulatory surgery facilities have the necessary equipment and procedures in place to respond immediately to emergency situations. Any surgeon performing cosmetic surgery in an ambulatory facility should have admitting privileges at a nearby accredited hospital.
The American Society for Aesthetic Plastic Surgery (ASAPS), is recognized as the world's leading organization devoted entirely to aesthetic plastic surgery and cosmetic medicine of the face and body. ASAPS is comprised of over 2,600 Plastic Surgeons; Active Members are certified by the American Board of Plastic Surgery (USA) or by the Royal College of Physicians and Surgeons of Canada and have extensive training in the complete spectrum of surgical and nonsurgical aesthetic procedures. International Active Members are certified by equivalent boards of their respective countries. All members worldwide adhere to a strict Code of Ethics and must meet stringent membership requirements.
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