Increased Intraabdominal Pressure in Abdominoplasty: Delineation of Risk Factors
Abdominoplasty is associated with a 1.1 percent risk of deep venous thrombosis. This has been attributed to rectus plication causing intraabdominal hypertension, known to effect decreased venous return, venous stasis, and thus thrombosis. The authors conducted a pilot study to determine which compon...
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| Veröffentlicht in: | Plastic and reconstructive surgery (1963) 2007-04, Vol.119 (4), p.1319-1325 |
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| creator | Huang, Georgeanna J. Bajaj, Anureet K. Gupta, Subhas Petersen, Floyd Miles, Duncan A. G. |
| description | Abdominoplasty is associated with a 1.1 percent risk of deep venous thrombosis. This has been attributed to rectus plication causing intraabdominal hypertension, known to effect decreased venous return, venous stasis, and thus thrombosis. The authors conducted a pilot study to determine which components of the abdominoplasty procedure (i.e., general anesthesia, flexion of the bed, plication, and/or binder placement) may elevate intraabdominal pressures and whether this was clinically relevant.
Twelve abdominoplasty and 10 breast reduction (control) patients were enrolled prospectively. Intraabdominal pressure was transduced through the bladder before plication in the supine and flexed positions, after plication in both positions, after skin closure in the flexed position, and on postoperative day 1 with and without a binder in the flexed position.
All intraabdominal pressures measured were clinically insignificant ( |
| doi_str_mv | 10.1097/01.prs.0000254529.51696.43 |
| format | Article |
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Twelve abdominoplasty and 10 breast reduction (control) patients were enrolled prospectively. Intraabdominal pressure was transduced through the bladder before plication in the supine and flexed positions, after plication in both positions, after skin closure in the flexed position, and on postoperative day 1 with and without a binder in the flexed position.
All intraabdominal pressures measured were clinically insignificant (<20 mm Hg). A statistically significant increase was found from flexion of the bed (mean difference, 3.80 +/- 2.0, p < 0.001, in the control group; and 4.39 +/- 1.68, p < 0.001, in the study group); rectus plication (mean difference, 2.78 +/- 2.11, p = 0.001, in the supine position; and 2.03 +/- 2.48, p = 0.016, in the flexed position); and binder placement (2.63 mm Hg for no binder versus 4.5 mm Hg with binder, p = 0.004). Both groups also showed an increase from preoperative to skin closure (mean difference, 2.03 +/- 6.7, p = 0.035, for the control group; and 2.83 +/- 3.97, p = 0.031, for the study group), suggesting general anesthesia as a risk factor.
This study confirms the effect of rectus plication on increasing intraabdominal pressures but also implicates bed position, binder placement, and general anesthetic as risk factors. A larger study is needed to clarify the role of these variables in elevating intraabdominal pressure during abdominoplasty.</description><identifier>ISSN: 0032-1052</identifier><identifier>EISSN: 1529-4242</identifier><identifier>DOI: 10.1097/01.prs.0000254529.51696.43</identifier><identifier>PMID: 17496607</identifier><language>eng</language><publisher>Hagerstown, MD: American Society of Plastic Surgeons</publisher><subject>Abdominal Cavity - physiopathology ; Abdominal Wall - physiopathology ; Abdominal Wall - surgery ; Adult ; Biological and medical sciences ; Body Mass Index ; Female ; Humans ; Linear Models ; Lipectomy - adverse effects ; Medical sciences ; Middle Aged ; Obesity, Morbid - surgery ; Pilot Projects ; Postoperative Complications ; Pressure ; Probability ; Prognosis ; Prospective Studies ; Rectus Abdominis - surgery ; Risk Assessment ; Statistics, Nonparametric ; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases ; Treatment Outcome</subject><ispartof>Plastic and reconstructive surgery (1963), 2007-04, Vol.119 (4), p.1319-1325</ispartof><rights>American Society of Plastic Surgeons</rights><rights>2007 INIST-CNRS</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3925-4cf946f7433220bd54e1b51166448b67c5d3c1d6daa5a300e41f7fab2ff88e4e3</citedby><cites>FETCH-LOGICAL-c3925-4cf946f7433220bd54e1b51166448b67c5d3c1d6daa5a300e41f7fab2ff88e4e3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27901,27902</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=18631705$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/17496607$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Huang, Georgeanna J.</creatorcontrib><creatorcontrib>Bajaj, Anureet K.</creatorcontrib><creatorcontrib>Gupta, Subhas</creatorcontrib><creatorcontrib>Petersen, Floyd</creatorcontrib><creatorcontrib>Miles, Duncan A. G.</creatorcontrib><title>Increased Intraabdominal Pressure in Abdominoplasty: Delineation of Risk Factors</title><title>Plastic and reconstructive surgery (1963)</title><addtitle>Plast Reconstr Surg</addtitle><description>Abdominoplasty is associated with a 1.1 percent risk of deep venous thrombosis. This has been attributed to rectus plication causing intraabdominal hypertension, known to effect decreased venous return, venous stasis, and thus thrombosis. The authors conducted a pilot study to determine which components of the abdominoplasty procedure (i.e., general anesthesia, flexion of the bed, plication, and/or binder placement) may elevate intraabdominal pressures and whether this was clinically relevant.
Twelve abdominoplasty and 10 breast reduction (control) patients were enrolled prospectively. Intraabdominal pressure was transduced through the bladder before plication in the supine and flexed positions, after plication in both positions, after skin closure in the flexed position, and on postoperative day 1 with and without a binder in the flexed position.
All intraabdominal pressures measured were clinically insignificant (<20 mm Hg). A statistically significant increase was found from flexion of the bed (mean difference, 3.80 +/- 2.0, p < 0.001, in the control group; and 4.39 +/- 1.68, p < 0.001, in the study group); rectus plication (mean difference, 2.78 +/- 2.11, p = 0.001, in the supine position; and 2.03 +/- 2.48, p = 0.016, in the flexed position); and binder placement (2.63 mm Hg for no binder versus 4.5 mm Hg with binder, p = 0.004). Both groups also showed an increase from preoperative to skin closure (mean difference, 2.03 +/- 6.7, p = 0.035, for the control group; and 2.83 +/- 3.97, p = 0.031, for the study group), suggesting general anesthesia as a risk factor.
This study confirms the effect of rectus plication on increasing intraabdominal pressures but also implicates bed position, binder placement, and general anesthetic as risk factors. A larger study is needed to clarify the role of these variables in elevating intraabdominal pressure during abdominoplasty.</description><subject>Abdominal Cavity - physiopathology</subject><subject>Abdominal Wall - physiopathology</subject><subject>Abdominal Wall - surgery</subject><subject>Adult</subject><subject>Biological and medical sciences</subject><subject>Body Mass Index</subject><subject>Female</subject><subject>Humans</subject><subject>Linear Models</subject><subject>Lipectomy - adverse effects</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Obesity, Morbid - surgery</subject><subject>Pilot Projects</subject><subject>Postoperative Complications</subject><subject>Pressure</subject><subject>Probability</subject><subject>Prognosis</subject><subject>Prospective Studies</subject><subject>Rectus Abdominis - surgery</subject><subject>Risk Assessment</subject><subject>Statistics, Nonparametric</subject><subject>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</subject><subject>Treatment Outcome</subject><issn>0032-1052</issn><issn>1529-4242</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2007</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpFkN1qFEEQhRtRzGb1FWQQ9G7G6v-d3IVo4kLAIHrd9PRUkzG902vXDCFv77i7sHVTVPFVncNh7COHhkNrvwBv9oUaWEpopUXbaG5a0yj5iq34MtdKKPGarQCkqDloccEuif4AcCuNfssuuFWtMWBX7GE7hoKesK-241S87_q8G0afqoeCRHPBahir6-M275On6eWq-oppGNFPQx6rHKufAz1Vtz5MudA79ib6RPj-1Nfs9-23Xzff6_sfd9ub6_s6yFboWoXYKhOtklII6HqtkHeac2OU2nTGBt3LwHvTe6-9BEDFo42-EzFuNqhQrtnn4999yX9npMntBgqYkh8xz-QsaJDa8AW8OoKhZKKC0e3LsPPlxXFw__N0wJcVuXOe7pCnW7yt2YeTytztsD-fngJcgE8nwFPwKRY_hoHO3MZIvlhZOHXknnOasNBTmp-xuEf0aXo8SBstVS0ALCjgUB_MyH_2HI7T</recordid><startdate>20070401</startdate><enddate>20070401</enddate><creator>Huang, Georgeanna J.</creator><creator>Bajaj, Anureet K.</creator><creator>Gupta, Subhas</creator><creator>Petersen, Floyd</creator><creator>Miles, Duncan A. G.</creator><general>American Society of Plastic Surgeons</general><general>Lippincott Williams & Wilkins</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20070401</creationdate><title>Increased Intraabdominal Pressure in Abdominoplasty: Delineation of Risk Factors</title><author>Huang, Georgeanna J. ; Bajaj, Anureet K. ; Gupta, Subhas ; Petersen, Floyd ; Miles, Duncan A. G.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3925-4cf946f7433220bd54e1b51166448b67c5d3c1d6daa5a300e41f7fab2ff88e4e3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2007</creationdate><topic>Abdominal Cavity - physiopathology</topic><topic>Abdominal Wall - physiopathology</topic><topic>Abdominal Wall - surgery</topic><topic>Adult</topic><topic>Biological and medical sciences</topic><topic>Body Mass Index</topic><topic>Female</topic><topic>Humans</topic><topic>Linear Models</topic><topic>Lipectomy - adverse effects</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Obesity, Morbid - surgery</topic><topic>Pilot Projects</topic><topic>Postoperative Complications</topic><topic>Pressure</topic><topic>Probability</topic><topic>Prognosis</topic><topic>Prospective Studies</topic><topic>Rectus Abdominis - surgery</topic><topic>Risk Assessment</topic><topic>Statistics, Nonparametric</topic><topic>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Huang, Georgeanna J.</creatorcontrib><creatorcontrib>Bajaj, Anureet K.</creatorcontrib><creatorcontrib>Gupta, Subhas</creatorcontrib><creatorcontrib>Petersen, Floyd</creatorcontrib><creatorcontrib>Miles, Duncan A. G.</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Plastic and reconstructive surgery (1963)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Huang, Georgeanna J.</au><au>Bajaj, Anureet K.</au><au>Gupta, Subhas</au><au>Petersen, Floyd</au><au>Miles, Duncan A. G.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Increased Intraabdominal Pressure in Abdominoplasty: Delineation of Risk Factors</atitle><jtitle>Plastic and reconstructive surgery (1963)</jtitle><addtitle>Plast Reconstr Surg</addtitle><date>2007-04-01</date><risdate>2007</risdate><volume>119</volume><issue>4</issue><spage>1319</spage><epage>1325</epage><pages>1319-1325</pages><issn>0032-1052</issn><eissn>1529-4242</eissn><abstract>Abdominoplasty is associated with a 1.1 percent risk of deep venous thrombosis. This has been attributed to rectus plication causing intraabdominal hypertension, known to effect decreased venous return, venous stasis, and thus thrombosis. The authors conducted a pilot study to determine which components of the abdominoplasty procedure (i.e., general anesthesia, flexion of the bed, plication, and/or binder placement) may elevate intraabdominal pressures and whether this was clinically relevant.
Twelve abdominoplasty and 10 breast reduction (control) patients were enrolled prospectively. Intraabdominal pressure was transduced through the bladder before plication in the supine and flexed positions, after plication in both positions, after skin closure in the flexed position, and on postoperative day 1 with and without a binder in the flexed position.
All intraabdominal pressures measured were clinically insignificant (<20 mm Hg). A statistically significant increase was found from flexion of the bed (mean difference, 3.80 +/- 2.0, p < 0.001, in the control group; and 4.39 +/- 1.68, p < 0.001, in the study group); rectus plication (mean difference, 2.78 +/- 2.11, p = 0.001, in the supine position; and 2.03 +/- 2.48, p = 0.016, in the flexed position); and binder placement (2.63 mm Hg for no binder versus 4.5 mm Hg with binder, p = 0.004). Both groups also showed an increase from preoperative to skin closure (mean difference, 2.03 +/- 6.7, p = 0.035, for the control group; and 2.83 +/- 3.97, p = 0.031, for the study group), suggesting general anesthesia as a risk factor.
This study confirms the effect of rectus plication on increasing intraabdominal pressures but also implicates bed position, binder placement, and general anesthetic as risk factors. A larger study is needed to clarify the role of these variables in elevating intraabdominal pressure during abdominoplasty.</abstract><cop>Hagerstown, MD</cop><pub>American Society of Plastic Surgeons</pub><pmid>17496607</pmid><doi>10.1097/01.prs.0000254529.51696.43</doi><tpages>7</tpages></addata></record> |
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| subjects | Abdominal Cavity - physiopathology Abdominal Wall - physiopathology Abdominal Wall - surgery Adult Biological and medical sciences Body Mass Index Female Humans Linear Models Lipectomy - adverse effects Medical sciences Middle Aged Obesity, Morbid - surgery Pilot Projects Postoperative Complications Pressure Probability Prognosis Prospective Studies Rectus Abdominis - surgery Risk Assessment Statistics, Nonparametric Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases Treatment Outcome |
| title | Increased Intraabdominal Pressure in Abdominoplasty: Delineation of Risk Factors |
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