Three Decades of Hematoma Prevention in Plastic Surgery: 44,133 Consecutive Cases Leading to an Evidence-Based Protocol
Methods/Technique: All cases were performed by board-certified plastic surgeons at an accredited outpatient facility between 1995 and 2024. Patient demographics, procedural data, and hematoma rates were recorded. Hematoma rates were compared before and after implementing a 5-Step Hematoma Prevention Protocol consisting of 1) thorough preoperative patient optimization, 2) normotensive anesthesia, and perioperative blood pressure management, 3) Intraoperative meticulous hemostasis, 4) Intraoperative Tranexamic Acid (TXA) administration, and 5) postoperative drain placement. TXA was utilized in facelifts and breast procedures, but not in abdominoplasties. Additionally, each protocol component was graded per the American Society of Plastic Surgeons' Evidence Rating and Grading Scales.
Results/Complications: A total of 44,133 consecutive cases were analyzed, with an overall hematoma rate of 0.46% (n=203). Hematoma rates were highest in abdominoplasty (0.8%, n=35), followed by breast procedures (0.76%, n=115) and face procedures (0.53%, n=51). The introduction of the 5-Step Hematoma Prevention Protocol corresponded with a downward trend in hematoma rates, with a 68.8% decrease from 0.64% (n=166, 26,032 patients) during 1995-2017 to 0.2% (n=37, 18,101 patients) during 2017-2024 (p<0.0001). Procedure-specific trends showed a 49.4% reduction in hematoma rates for breast procedures (0.96% vs. 0.49%; p=0.0009) and a 91.03% reduction for face procedures (0.74% vs. 0.06%; p<0.0001). In abdominoplasties, where TXA was not administered in either cohort, hematoma rates showed only a modest decline of 6.7% (0.82% vs. 0.77%; p=0.8655).
Conclusion: This study represents the largest single-center analysis to date, encompassing 44,133 cases performed over three decades, with a focus on hematoma prevention strategies. We present a comprehensive 5-Step Hematoma Prevention Protocol that integrates evidence-based measures, significantly enhancing patient safety in outpatient plastic surgery.
|
|
Hematoma Rates 1995-2017 |
Hematoma rates 2017-2024 |
Rate Change (%) |
p Value |
|
All procedures |
0.64% |
0.20% |
68.75% |
p<0.0001* |
|
Face procedures |
0.74% |
0.06% |
91.03% |
p<0.0001* |
|
Breast procedures |
0.96% |
0.49% |
49.39% |
p=0.0009* |
|
Abdominoplasties |
0.82% |
0.77% |
6.71% |
p=0.8655 |