From the Guidelines
Combining plastic surgery procedures does not significantly increase the risk of adverse outcomes, such as major cardiac complications, in patients with low perioperative risk. The risk of major adverse cardiac events (MACE) is generally low for plastic surgery procedures, which are considered to be among the lowest-risk operations 1. According to the 2014 ACC/AHA guideline on perioperative cardiovascular evaluation and management of patients undergoing noncardiac surgery, plastic surgery is associated with a very low risk of MACE 1.
When considering the combination of plastic surgery procedures, the primary concerns include longer anesthesia exposure, increased blood loss, and extended recovery times. However, for patients with low perioperative risk, as assessed by tools like the Revised Cardiac Risk Index (RCRI), the risk of major cardiac complications is not significantly increased 1. The RCRI has 6 predictors of risk for major cardiac complications, and patients with 0 or 1 predictor(s) of risk are considered to have a low risk of MACE 1.
Key considerations for combining plastic surgery procedures include:
- Limiting combined procedures to those that can be safely completed within a reasonable operative time
- Involving similar body regions to minimize recovery complexity
- Assessing patient risk factors, such as diabetes, heart disease, and smoking, which can increase the risk of adverse outcomes
- Staging procedures when necessary to minimize risk and optimize recovery 1.
Overall, the decision to combine plastic surgery procedures should be individualized, taking into account the patient's overall health, the specific procedures being considered, and the potential risks and benefits 1.
From the Research
Risk of Adverse Outcomes in Combined Plastic Surgery Procedures
- The risk of complications in combined plastic surgery procedures is a significant concern, with studies indicating a higher complication rate for combined procedures compared to index procedures 2.
- A retrospective cohort analysis using the Tracking Operations and Outcomes for Plastic Surgeons database found that the 30-day overall complication rate was 5.0%, with a higher complication rate for combined procedures (7.6% vs 4.2%) 2.
- Certain procedures, such as trunk liposuction and augmentation mammaplasty, are associated with increased risk of complications when combined with other procedures 2.
- However, abdominoplasty and mastopexy may be combined with other plastic surgery procedures without increased risk to patients 2.
Factors Influencing Complication Rates
- Increased operative time is a common independent risk factor predictive of complications, including surgical site infection and related reoperation 3.
- Microsurgical procedures are associated with higher complication rates, with 19.33% of cases experiencing at least one complication 3.
- The use of antifibrinolytic agents, such as tranexamic acid, may help reduce bleeding and complications in plastic surgery procedures, but more research is needed to fully understand its benefits and risks 4, 5, 6.
Implications for Plastic Surgery Practice
- Plastic surgeons should carefully consider the risks and benefits of combining multiple procedures in a single operative session 2.
- The use of tranexamic acid and other antifibrinolytic agents may be beneficial in reducing bleeding and complications, but further research is needed to determine its safety and efficacy in plastic surgery 4, 5, 6.
- Increased operative time should be minimized whenever possible, and two-team approaches and staged operations may be explored to reduce the risk of complications 3.