Multiple Procedures and Staging in the Massive Weight Loss Population
Devin Coon, B.A., Jeffrey A. Gusenoff, M.D., J. Peter Rubin, M.D..
University of Pittsburgh, Pittsburgh, PA, USA.
Background: Body contouring after massive weight loss is one of the fastest growing areas of plastic surgery. As no single procedure can address all deformities, patients frequently seek to have multiple procedures performed concomitantly in order to reduce costs and recovery time. We present our experience with and approach to multiple procedure cases.
Methods: 449 body contouring patients were enrolled in a prospective registry over 6 years. Separate surgical categories included breast (mastopexy or augmentation), thigh lift, lower or upper body lift, brachioplasty, and abdominal contouring. ANOVA and ordered logistic regression were used to analyze differences between procedure combinations while the t-test was used for two-group comparison.
Results: 449 patients (407 female, 42 male) had 511 operations. Patients undergoing multiple procedures were not significantly different in gender, pre-weight loss BMI, current BMI, or incidence of comorbidities (hypertension, diabetes, anemia, CVD). Multiple procedure patients were significantly older (45.6±10.1 versus 42.6±10.2) and had longer cases (6.3±0.2 hours versus 2.2±0.1) with higher complication rates (51.8% versus 25.4%).
35 cases (7%) were excluded due to involving procedures outside the major categories of analysis. Table 1 shows complication rates by the number of procedures performed. There were no occurrences of thromboembolism. Hospital stay increased with the number of procedures performed (1.4 days for 1 procedure to 2.4 in 4+ procedures; p<0.001).
58 cases (11.3%) involved a patient undergoing a second stage operation while 4 cases (1%) involved a third stage. Second stage cases were likelier to involve more procedures (1.7 versus 1.2; p<0.001) but did not have higher complication rates (p = 0.8). Hospital stay was not significantly different between second stage and unstaged cases (1.6 versus 1.4 days; p = 0.17).
Conclusions: Concomitant procedures can safely be performed in carefully selected massive weight loss patients. While minor complication rates are higher than in single procedure cases, this must be weighed against the combined risks of multiple surgical events. Staging offers an alternative for patients who are poor candidates for large cases or who desire procedures that cannot be combined.
|Proc. Count||Cases (%)||Intraop|
|1||265 (56%)||2.8 ± 1.8||31%||3%||7%||5%||7%||13%|
|2||114 (24%)||6.4 ± 2.3||48%||4%||18%||11%||9%||27%|
|3||83 (17%)||9.2 ± 2.2||72%||4%||34%||7%||11%||43%|
|4-5||14 (3%)||11.0 ± 1.8||67%||7%||14%||14%||7%||57%|