Revisiting Ehlers-Danlos Syndrome as a Relative Contraindication to Elective Plastic Surgery: A Retrospective Matched Cohort Study.

Abstract

Ehlers-Danlos syndrome (EDS) comprises a heterogeneous group of connective tissue disorders, often associated with concerns about poor wound healing and elevated surgical complication rates. This study evaluated the safety of elective plastic surgery in patients with EDS relative to matched controls. The authors hypothesized that patients with EDS would not experience higher complication rates relative to matched controls. An institutional review board-approved retrospective cohort study of EDS patients and matched controls who underwent elective plastic surgery between 2003 and 2023 was conducted at a tertiary health care system. Patients were matched for comorbidities, medications, and other factors affecting wound healing. Complication rates, categorized by severity and timing, were compared between groups. Data analysis included paired t tests and McNemar tests. To detect a complication rate difference of 10% (α = 0.05, β = 0.2), a sample of 97 patients per group was required. A total of 100 EDS patients (86% female; mean age ± SD, 43.29 ± 17.45 years; mean body mass index ± SD, 26.47 ± 6.01 kg/m 2 ) and 100 matched controls (86% female; mean age ± SD, 42.98 ± 18.12 years; mean body mass index ± SD, 26.82 ± 6.61 kg/m 2 ) were included. The most common EDS subtype was hypermobile EDS (41%), followed by classic (6%) and vascular EDS (2%). Complications were observed in 25% of EDS patients and 35% of controls ( P = 0.16). There was no significant difference in the rate of minor complications (EDS, 19%; controls, 24%; P = 0.39) or major complications (EDS, 6%; controls, 12%; P = 0.20). Elective plastic surgery can be performed safely in patients with EDS, particularly those with hypermobile EDS. Risk, II.