Aesthetic Plastic Surgery

, Volume 43, Issue 5, pp 1387–1395 | Cite as

Searching for the Best Way to Assess the Risk of Thrombosis in Aesthetic Plastic Surgery; The Role of the Caprini/Pannucci Score

  • Jesús Cuenca-PardoEmail author
  • Guillermo Ramos-Gallardo
  • Lázaro Cárdenas-Camarena
  • Livia Contreras-Bulnes
  • Gerardo Lelevier De Alvear
Original Article Patient Safety



There is concern regarding the high incidence of thrombosis in plastic surgery patients. For this reason, we wanted to compare the results of the Caprini/Pannucci score in patients with and without a past history of thrombosis admitted for aesthetic plastic surgery.


This was a case–control study of 152 patients undergoing aesthetic plastic surgery procedures. We formed two groups: Group I had 70 patients who had thrombosis after aesthetic plastic surgery and group II had 82 patients without thrombosis. We studied the considered risk factors for thrombosis. We weighted the factors according to the OR and linear regressions. We then related them to the Caprini/Pannucci score.


Patients in group I had a score of 5.68 versus 3.45 in group II (p < 0.001). There was a 9.86% increase in thrombosis for each increased point in the rating. A higher effectiveness of the Caprini score was found in the high-score group; the greatest flaw was in the low-scoring group. The sensitivity was 75.71%, and the specificity was 70.73%. The factors with the greatest impact were the infiltration of fat in the buttocks, degree of obesity and time of surgery. There was an increased risk of thrombosis in patients with gluteal fat injections, varicose veins, obesity and immune disorders as well as those who had previously given birth.


To increase the effectiveness of the score and to use the score as a basis on which to decide upon prophylactic care, it is necessary to modify the score and add some factors.

Level of Evidence III

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors


Thrombosis Thromboembolism risk factors Caprini/Pannucci score Aesthetic plastic surgery patients Aesthetic surgery procedures Caprini risk assessment 


Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical Approval

The study was approved by the Committee de Seguridad de la Asociacion Mexicana de Cirugía Plástica, Estética y Reconstructiva.

Human and Animal Rights

This was a retrospective clinical study based on a review of clinical files without direct participation of the patients. Therefore, there was no risk to any patient, and the confidentiality of patients and surgeons was maintained.

Informed Consent

For this type of study, informed consent is not required.


  1. 1.
    Cabrera-Rayo A, Nellen-Hummel H (2007) Epidemiología de la enfermedad tromboembólica venosa. Gac Méd Méx 143(1):3–5Google Scholar
  2. 2.
    Zaragoza-Delgadillo JC, Sauri-Arce JCA, Ochoa-Carrillo FJ, Fuentes-del-Toro F (2007) Prevención de la enfermedad tromboembólica venosa en cirugía. Gac Méd Méx 143(1):35–39Google Scholar
  3. 3.
    Cuenca-Pardo JA, Contreras-Bulnes L, Iribarren-Moreno R, Hernández-Valverde C (2014) Sudden death in patients of liposuction: preventive recommendations. Analytical study. Cirugía Plástica 24(1):16–30Google Scholar
  4. 4.
    Winocour J, Gupta V, Ramírez JR, Shack RB, Grotting JC, Higdon KK (2015) Abdominoplasty: risk factor, complications rates, and safety of combined procedures. Plast Reconstr Surg 136:597e–606eCrossRefPubMedGoogle Scholar
  5. 5.
    Pannucci CJ (2018) Venous thromboembolism in aesthetic surgery: risk optimization in the preoperative, intraoperative, and postoperative settings. Aesthet Surg J. CrossRefPubMedGoogle Scholar
  6. 6.
    Pannucci CJ, Bailey SH, Dreszer G, Wachtman CF, Zumsteg JW, Jaber RM, Hamill JB, Hume KM, Rubin JP, Neligan PC, Kalliainen LK, Hoxworth RE, Pusic AL, Wilkins EG (2011) Validation of the Caprini risk assessment model in aesthetic plastic and reconstructive surgery patients. J Am Coll Surg 212(1):105–112CrossRefPubMedGoogle Scholar
  7. 7.
    Pastor-Torres LF, Antigao-Ramírez R, Honorato-Pérez JM, Junquera-Planas CM, Navarro-Salas E et al (2001) Guías de práctica clínica de la Sociedad Española de Cardiología en la valoración del riesgo quirúrgico del paciente cardiópata sometido a cirugía no cardíaca. Rev Esp Cardiol 54:186–193CrossRefGoogle Scholar
  8. 8.
    Henke P, Pannucci CH (2010) VTE risk factor assessment and prophylaxis. Phlebology 25(5):219–223CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Ibarra P, Arango J, Bayter J, Castro J, Cortes J et al (2010) Consenso de la Sociedad Colombiana de Anestesiología y Reanimación, SCARE y de la Sociedad Colombiana de Cirugía Plástica, sobre las recomendaciones para el manejo de pacientes electivos de bajo riesgo. Rev Colomb Anestesiol 37(4):390–403CrossRefGoogle Scholar
  10. 10.
    Geerts WH, Bergqvist D, Pineo GF, Heit JA, Samama ChM, Lassen MR, Colwell CW (2008) Prevention of venous thromboembolism. American College of chest physicians evidence-based clinical practice guidelines (8th edition). Chest 133:381S–453SCrossRefGoogle Scholar
  11. 11.
    Caprini JA, Arcelus JI, Reyna JJ (2001) Effective risk stratification of surgical and nonsurgical patients for venous thromboembolic disease. Semin Hematol 38:12–19CrossRefPubMedGoogle Scholar
  12. 12.
    Pannucci ChJ (2017) Evidence-based recipes for venous thromboembolism prophylaxis: a practical safety guide. Plast Reconstr Surg 139:520e–532eCrossRefPubMedGoogle Scholar
  13. 13.
    Swanson E (2013) Prospective clinical study of 551 cases of liposuction and abdominoplasty performed individually and in combination. Plast Reconstr Surg Glob Open 1(5):e32. CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Pannucci CJ, Barta RJ, Portschy PR, Dreszer G, Hoxworth RE, Kalliainen LK, Wilkins EG (2012) Assessment of postoperative venous thromboembolism risk in plastic surgery patients using the 2005 and 2010 Caprini Risk score. Plast Reconstr Surg 130(2):343–353CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Ramos-Gallardo G, Medina-Zamora P, Cardenas-Camarena L, Orozco-Rentería D, Duran-Vega H, Mota-Fonseca E (2017) Where does the transplanted fat is located in the gluteal region? J Investig Surg 29:1–4. CrossRefGoogle Scholar
  16. 16.
    Ramos-Gallardo G, Orozco-Rentería D, Medina-Zamora P, Mota-Fonseca E, García-Benavides L, Cuenca-Pardo J, Contreras-Bulnes L, Ambriz-Plasencia AR, Curiel-Beltran JA (2018) Prevention of fat embolism in fat injection for gluteal augmentation, anatomic study in fresh cadavers. J Investig Surg 31(4):292–297CrossRefGoogle Scholar
  17. 17.
    Cárdenas-Camarena L, Andrés Gerardo LP, Durán H, Bayter-Marin JE (2017) Strategies for reducing fatal complications in liposuction. Plast Reconstr Surg Glob Open 5(10):e1539CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Cárdenas-Camarena L, Bayter JE, Aguirre-Serrano H, Cuenca-Pardo J (2015) Deaths caused by gluteal lipoinjection: what are we doing wrong? Plast Reconstr Surg 136(1):58–66CrossRefPubMedGoogle Scholar
  19. 19.
    Ray DE et al (2005) The effect of body mass index on patient outcomes in a medical ICU. Chest 127(6):2125–2131CrossRefPubMedGoogle Scholar
  20. 20.
    Neville AL et al (2004) Obesity is an independent risk factor of mortality in severely injured blunt trauma patients. Arch Surg 139(9):983–987CrossRefPubMedGoogle Scholar
  21. 21.
    Reinish JF, Bresnick SD, Walker JW, Rosso RF (2001) Deep venous thrombosis and pulmonary embolus after face lift: a study of incidence and prophylaxis. Plast Reconstr Surg 107(6):1570–1575CrossRefGoogle Scholar
  22. 22.
    Stuzin JM, Baker TJ, Baker TM (2001) Deep venous thrombosis and pulmonary embolus after face lift: a study of incidence and prophylaxis (discussion). Plast Reconstr Surg 107:1576–1577CrossRefGoogle Scholar
  23. 23.
    Durnig P, Jungwirth W (2006) Low-molecular-weight heparin and postoperative bleeding in rhytidectomy. Plast Reconstr Surg 118:502–507CrossRefPubMedGoogle Scholar
  24. 24.
    Saad AN, Parina R, Chang D, Gosman AA (2014) Risk of adverse outcomes when plastic surgery procedures are combined. Plast Reconstr Surg 134(6):1415–1422CrossRefPubMedGoogle Scholar
  25. 25.
    Poore SO, Sillah N, Mahajan AY, Gotowski KA (2012) Patient safety in the operating room: II intraoperative and postoperative. Plast Reconstr Surg 130:1048–1058CrossRefPubMedGoogle Scholar
  26. 26.
    Zhou HX, Peng LQ, Yan Y et al (2012) Validation of the Caprini risk assessment model in Chinese hospitalised patients with venous thromboembolism. Thromb Res 130:735–740CrossRefPubMedGoogle Scholar
  27. 27.
    Nendaz M, Spirk D, Kucher N et al (2014) Multicentre validation of the Geneva Risk Score for hospitalised medical patients at risk of venous thromboembolism. Explicit ASsessment of Thromboembolic RIsk and Prophylaxis for Medical PATients in SwitzErland (ESTIMATE). Thromb Haemost 111:531–538CrossRefPubMedGoogle Scholar
  28. 28.
    Barbar S, Noventa F, Rossetto V et al (2010) A risk assessment model for the identification of hospitalised medical patients at risk for venous thromboembolism: the Padua Prediction Score. J Thromb Haemost 8:2450–2457CrossRefPubMedGoogle Scholar
  29. 29.
    Woller SC, Stevens SM, Jones JP et al (2011) Derivation and validation of a simple model to identify venous thromboembolism risk in medical patients. Am J Med 124:947–954CrossRefPubMedGoogle Scholar
  30. 30.
    Spyropoulos AC, Anderson FA Jr, Fitzgerald G et al (2011) Predictive and associative models to identify hospitalised medical patients at risk for VTE. Chest 140:706–714CrossRefPubMedGoogle Scholar
  31. 31.
    Rothberg MB, Lindenauer PK, Lahti M et al (2011) Risk factor model to predict venous thromboembolism in hospitalised medical patients. J Hosp Med 6:202–209CrossRefPubMedGoogle Scholar
  32. 32.
    Stuck AK, Spirk D, Schaudt J, Kucher N (2017) Risk assessment models for venous thromboembolism in acute ill medical patients. A systematic review. Thromb Haemost 117(4):801–808CrossRefPubMedGoogle Scholar
  33. 33.
    Duran H, Cardenas-Camarena L, Bayter-Marin E, Ramos-Gallardo G, Robles-Cervantes J (2018) Microscopic and macroscopic fat embolism: solving the puzzle with case reports. PRS 142(4):569e–577eGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature and International Society of Aesthetic Plastic Surgery 2019

Authors and Affiliations

  • Jesús Cuenca-Pardo
    • 1
    Email author
  • Guillermo Ramos-Gallardo
    • 1
  • Lázaro Cárdenas-Camarena
    • 1
  • Livia Contreras-Bulnes
    • 1
  • Gerardo Lelevier De Alvear
    • 1
  1. 1.Asociación Mexicana de Cirugía Plástica, Estética y ReconstructivaMexico CityMexico

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