American Association of Plastic Surgeons

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Three Decades Of Hematoma Prevention In Outpatient Plastic Surgery: 44,133 Consecutive Cases Leading To An Evidence-based Protocol
Tal Brown, BS, Rachel Rohrich, BS, Stav Brown, MD, John Burns, MD, Sameer Jejurikar, MD, Ricardo Meade, MD, Rod Rohrich, MD.
The Dallas Plastic Surgery Institute, Dallas, TX, USA.

PURPOSE: Hematoma prevention in outpatient plastic surgery is crucial for patient safety and procedural success. This study evaluates the impact of a 5-Step Hematoma Prevention Protocol on hematoma rates over three decades of outpatient cosmetic procedures.
METHODS: 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 the 5-Step Hematoma Prevention Protocol, with each protocol component graded per the American Society of Plastic Surgeons' Evidence Rating and Grading Scales.
RESULTS: 44,133 consecutive cases were analyzed, with an overall hematoma rate of 0.45 percent. Hematoma rates were the highest in abdominoplasty (0.8 percent), followed by breast procedures (0.77 percent) and facelift (0.44 percent). Introduction of the 5-Step Hematoma Prevention Protocol corresponded with a 68.75 percent decrease in hematoma rates, declining from 0.64 percent (n=166; 26,032 patients) in 1995-2017 to 0.2 percent (n=37; 18,101 patients) in 2017-2024.
CONCLUSION: This is the largest single-center study to date, encompassing 44,133 cases performed over three decades, focused on hematoma prevention strategies. We present a dedicated 5-Step Hematoma Prevention Protocol consisting of: 1) Preoperative patient optimization (Level III, Grade A); 2) Perioperative blood pressure management (Level II, Grade A); 3) Meticulous hemostasis (Level II, Grade A); 4) Tranexamic Acid (TXA) administration (Level I, Grade B); and 5) Postoperative monitoring and drain placement (Level III, Grade B). The protocol has significantly reduced hematoma rates in outpatient plastic surgery.
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