Abstract
BACKGROUND: Most deaths after outpatient plastic surgery are because of thromboembolic events, particularly pulmonary embolism (PE). The effectiveness of QUAD A deep vein thrombosis (DVT) safety measures after recent policy changes remains undocumented. OBJECTIVES: The aim of the authors of the study is to assess how adherence to DVT prophylaxis guidelines affects complications and mortality in QUAD A facilities. METHODS: Using the Patient Safety Data Reporting database, we retrospectively assessed DVT, PE, and mortality rates in adult patients at QUAD A facilities from 2019 to 2023, with subgroup analysis of plastic surgery centers. The authors analyzed demographics and complications relative to facility protocol compliance using descriptive statistics and regression analyses. RESULTS: The authors identified 3,338,519 surgeries and 247 DVT/PE events. Facility-level deficiencies in DVT/PE prophylaxis ranged from 7.4% to 14.17%; peak deficiencies coincided with the highest complications and mortality. Among DVT/PE patients, 67 underwent plastic surgery (mean age 47.7 years, standard deviation [SD: 11.8]; mean BMI 29.2 kg/m(2), [SD: 7.7]); 94% were women. The mean operative time was 220.4 min (SD: 115.9), with 98.5% of procedures under general anesthesia and nearly half of patients (49.3%) hospitalized postoperatively. Liposuction was most commonly associated with complications (38.8%), followed by multiple procedures (23.9%). Within plastic surgery, cosmetic procedures accounted for 73.1% of complications. Statistical analysis showed an association between liposuction and DVT/PE occurrence, with more favorable outcomes for cosmetic procedures (P = .038). CONCLUSIONS: Following a QUAD A policy change, DVT/PE rates peaked alongside DVT/PE prophylaxis deficiencies. Based on the findings of this study, the authors suggest considering a standardized prophylaxis and preoperative evaluation to reduce morbidity and mortality. Liposuction patients may be at higher risk for these complications.