Assessment of Mortality Rates Associated With Perioperative Deep Vein Thrombosis Screening and Prophylaxis in Cosmetic Outpatient Procedures: An Updated National Evaluation Using QUAD A Patient Safety Data

Background Most deaths after outpatient plastic surgery are due to thromboembolic events, particularly pulmonary embolism (PE). The effectiveness of QUAD A DVT safety measures after recent policy changes remains undocumented. Objectives To assess how adherence to deep vein thrombosis (DVT) prophylaxis guidelines affects complications and mortality in QUAD A facilities. Methods Using the Patient Safety Data Reporting (PSDR) database, we retrospectively assessed DVT, PE, and mortality rates in adult patients at QUAD A facilities from 2019-2023, with subgroup analysis of plastic surgery centers. We analyzed demographics and complications relative to facility protocol compliance using descriptive statistics and regression analyses. Results We identified 3,338,519 surgeries and 247 DVT/PE events. Facility-level deficiencies in DVT/PE prophylaxis ranged from 7.4% to 14.17%; peak deficiencies coincided with the highest complications and mortality. Among DVT/PE patients, 67 underwent plastic surgery (mean age 47.7 years, [SD: 11.8]; mean BMI 29.2 kg/m2, [SD: 7.7]); 94% were women. The mean operative time was 220.4 minutes (SD: 115.9), with 98.5% of procedures under general anesthesia and nearly half of patients (49.3%) hospitalized postoperatively. Liposuction was most commonly associated with complications (38.8%), followed by multiple procedures (23.9%). Within plastic surgery, cosmetic procedures accounted for 73.1% of complications. Statistical analysis showed an association between liposuction and DVT/PE occurrence, with more favorable outcomes for cosmetic procedures (p=0.038). Conclusions Following a QUAD A policy change, DVT/PE rates peaked alongside DVT/PE prophylaxis deficiencies. The findings in this study suggest considering a standardized prophylaxis and preoperative evaluation to reduce morbidity and mortality. Liposuction patients may be at higher risk for these complications.