Risk Factors for Postoperative Complications After Abdominal Panniculectomy and the Contribution of Plastic Surgeons on Reconstruction Following Massive Weight Loss

Abstract Background The goals of abdominoplasty in massive weight loss (MWL) patients are often functional, with a greater emphasis on safety than on aesthetic rejuvenation. As important as functional improvements and safety are, however, there may be room for increasing the aesthetic potential of abdominoplasties in these patients. Objectives To determine the safety of the pursuit of aesthetic goals for abdominoplasty in MWL patients. Methods This is a retrospective study examining 910 consecutive female patients consisting of three groups: postpartum (n=718), dietary MWL (n=65) and bariatric MWL (n=127). All patients were approached with a well-defined set of aesthetic goals which were pursued as needed and as feasible. Results The utilization of aesthetic abdominoplasty components was similar all groups, supporting the assertion that the groups were subjected to a similar aesthetic emphasis. Logistic regression showed that a history of bariatric MWL was an independent risk factor for multiple complications (OR 2.738, p=0.014), and that elevated BMI, smoking, diabetes and age were likewise independent risk factors for complications. Propensity score matched case-control pairs showed that bariatric MWL patients were more likely than dietary MWL patients to experience multiple complications (9.52% vs 0 percent, p=0.031). Conclusions Bariatric MWL patients but not dietary weight loss patients seem to have higher risk than postpartum patients. Other comorbidities (elevated BMI, smoking, diabetes, age) seem to be more important predictors of complications than MWL status. Select MWL patients can likely be approached with an emphasis on aesthetic goals, without increasing risks as compared to the postpartum population.

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Rapid Bodyweight Reduction before Lumbar Fusion Surgery Increased Postoperative Complications

Asian Spine Journal ◽

10.31616/asj.2019.0236 ◽

2020 ◽

Vol 14 (5) ◽

pp. 613-620

Author(s):

Hayeem L. Rudy ◽

Woojin Cho ◽

Brittany A. Oster ◽

Sandip Parshottam Tarpada ◽

Erin Moran-Atkin

Keyword(s):

Weight Loss ◽

Postoperative Complications ◽

Lumbar Fusion ◽

The United States ◽

Massive Weight Loss ◽

Blood Transfusions ◽

Fusion Surgery ◽

Lumbar Fusion Surgery ◽

Weight Loss Group ◽

History Of

Study Design: Retrospective cohort study.Purpose: To determine the effects of massive weight loss on perioperative complications after lumbar fusion surgery (LFS).Overview of Literature: Patients who are obese are more likely to experience low back pain, which would require LFS. Nonetheless, they have a higher risk of perioperative complication development compared with individuals who are not obese.Methods: Patients who underwent LFS at hospitals that participated in the National Surgical Quality Improvement Program database within the United States between 2005 and 2015. Outcomes included 30-day medical complications, surgical complications, and length of stay (LOS). We analyzed a total of 39,742 patients with the use of the International Classification of Disease, ninth revision codes. The patients were categorized in the following two groups: group 1, individuals with a history of massive weight loss within 6 months before LFS, and group 2, individuals without a history of massive weight loss before surgery. Massive weight loss was defined as loss of 10% of total body weight. Patients with a history of malignancy or chronic disease were excluded from the study. Patients in each group were randomly matched based on age, gender, sex, smoking status, and body mass index. Paired two-tailed Student t -tests were used to compare the outcomes.Results: Of the 39,742 patients identified, 129 (0.32%) met the criteria for inclusion in the weight loss group (WL group) and were successfully matched to individuals in the non-weight loss group (non-WL group). Compared with the non-WL group, the WL group had a significantly longer LOS (9.7 vs. 4.0 days, p <0.05), higher surgical site infections (SSIs) (8.0 vs. 3.0, p <0.05), increased number of blood transfusions (40.0 vs. 20.0, p <0.05), and greater deep vein thrombosis (DVTs) (5.0 and 0.00, p <0.05).Conclusions: On a nationwide scale, rapid weight loss before LFS is associated with a higher rate of postoperative complications, including SSI and DVTs, longer average LOS, and more frequent blood transfusions.

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