Jennifer Heller

Johns Hopkins Medicine, Baltimore, MD, United States

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Publications (3)9.64 Total impact

  • Michele A Shermak, David C Chang, Jennifer Heller
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    ABSTRACT: The purpose of this study was to define the risk of venous thromboembolism within the massive weight loss population undergoing body contouring procedures. Retrospective analysis of massive weight loss patients who had body contouring operations between March of 1998 and September of 2004 was performed. Patient factors studied included age, gender, medical comorbidities including history of thromboembolic complications, depression, tobacco use, preoperative/postoperative body mass index, surgery, and transfusion. There were 138 cases, and the female-to-male ratio was 5:1. Procedures were often combined: 128 patients had abdominal surgery, 36 had a back lift, 41 had brachioplasty, 29 had chest surgery, and 47 had a thigh lift. The most common complications were related to healing (n = 28) and seroma (n = 18). Three patients had postoperative deep venous thrombosis requiring anticoagulation, and one had a fatal pulmonary embolism, making the overall venous thromboembolism risk 2.9 percent. The mean body mass index at contour was 48.5 for patients with venous thromboembolism versus 31.8 for patients who did not develop venous thromboembolism (p = 0.01). Looking at this subgroup of 45 patients, the risk of venous thromboembolism was 8.9 percent, with no risk found in patients with a body mass index less than 35 (p = 0.01). The risk of venous thromboembolism with contouring surgery for massive weight loss is comparable to that for gastric bypass surgery. Body mass index in the obese range appears to be a leading risk factor. The authors' data support routine prophylaxis against venous thromboembolism. Recommendations for high-risk patients are discussed.
    Plastic and Reconstructive Surgery 05/2007; 119(5):1590-6; discussion 1597-8. · 3.33 Impact Factor
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    ABSTRACT: There is increasing evidence that 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors (statins) reduce cardiovascular and cerebrovascular events through anti-inflammatory, plaque stabilization, and neuroprotective effects independent of lipid lowering. This study was designed to investigate whether statin use reduces the incidence of perioperative stroke and mortality among patients undergoing carotid endarterectomy (CEA). All patients undergoing CEA from 1994 to 2004 at a large academic medical center were retrospectively reviewed. The independent association of statin use and perioperative morbidity was assessed via multivariate logistic regression analysis. CEA was performed by 13 surgeons on 1566 patients (987 men and 579 women; mean age, 72 +/- 10 years), including 1440 (92%) isolated and 126 (8%) combined CEA/coronary artery bypass grafting procedures. The indication for CEA was symptomatic disease in 660 (42%) cases. Six hundred fifty-seven (42%) patients received a statin medication for at least 1 week before surgery. Statin use was associated with a reduction in perioperative strokes (1.2% vs 4.5%; P < .01), transient ischemic attacks (1.5% vs 3.6%; P < .01), all-cause mortality (0.3% vs 2.1%; P < .01), and median (interquartile range) length of hospitalization (2 days [2-5 days] vs 3 days [2-7 days]; P < .05). Adjusting for all demographics and comorbidities in multivariate analysis, statin use independently reduced the odds of stroke threefold (odds ratio [95% confidence interval], 0.35 [0.15-0.85]; P < .05) and death fivefold (odds ratio [95% confidence interval], 0.20 [0.04-0.99]; P < .05). These data suggest that perioperative statin use may reduce the incidence of cerebrovascular events and mortality among patients undergoing CEA.
    Journal of Vascular Surgery 11/2005; 42(5):829-36; discussion 836-7. · 2.98 Impact Factor
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    ABSTRACT: Thromboembolism is a dreaded complication of surgery in multiple disciplines, including plastic surgery, and deep venous thrombosis and pulmonary embolus cause significant morbidity, even death. This article provides methods for understanding and preventing deep venous thrombosis and pulmonary embolus in plastic surgery.
    Plastic and Reconstructive Surgery 03/2005; 115(2):20e-30e. · 3.33 Impact Factor