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2008 Annual Meeting Abstracts


Body Mass and Surgical Complications in the Post-Bariatric Reconstructive Patient: Analysis of 511 Cases
Devin Coon, B.A., Jeffrey A. Gusenoff, M.D., J. Peter Rubin, M.D..
University of Pittsburgh, Pittsburgh, PA, USA.

BACKGROUND: An increasing number of patients are presenting after massive weight loss due to bariatric surgery or diet and exercise. Many of these patients have residual obesity which may compromise outcomes. We sought to analyze the impact of body mass indices on body contouring surgery complications.
METHODS: 449 patients were enrolled in a prospective registry over 6 years. Measures included medical complications and comorbidities. Cases were analyzed in three groups: all cases, single procedure cases (Group I), and multiple procedure cases (Group II).
RESULTS: 449 patients (407 female, 42 male) with a mean age of 44.5 ± 10.3 underwent 511 separate operations. Mean pre-weight loss BMI (MaxBMI) was 51.6 ± 9.5 kg/m2, post-weight loss BMI (CurrentBMI) was 29.3 ± 5.0 and the ΔBMI was 22.3 ± 7.5. For all cases (n=511), the presence of a surgical complication was directly related to MaxBMI (p=0.002) and ΔBMI (p=0.002) but not CurrentBMI.
Group I consisted of 194 single procedure cases. Complications in Group I were related to MaxBMI (p=0.006) and CurrentBMI (p=0.02) but not ΔBMI. MaxBMI impacted infections (p=0.003) while CurrentBMI impacted dehiscence (p=0.009) and infections (p=0.03). Group II consisted of 317 cases with only ΔBMI directly related to overall complications (p=0.01).
CONCLUSIONS: Body mass indices influence complications in body contouring. Current BMI may impact complications in single-procedure cases but appears to play less of a role in larger cases. Careful patient selection, assessment of surgical complexity and recognition of the particular risks increased by residual obesity can help to optimize outcomes in this patient population.
Table 1: Patient Demographics and Clinical Characteristics
All Patients
N = 449
Group I*
N = 171
Group II*
N = 278
P-value
Age (years)
Mean±sd
Range
44.5±10.3
18-76
42.6±10.2
19-72
45.6±10.1
18-76

0.002
Gender
Female
90.7%89.5%91.4%0.5
Current BMI (Kg/m2)
Mean±sd
Range
29.3±5.0
18.6-53.4
29.5±5.3
18.6-53.4
29.1±4.8
20.8-52.6
0.5
Max BMI (Kg/m2)
Mean±sd
Range
51.6±9.5
31.0-112.5
51.0±9.1
35.7-112.5
52.0±9.8
31.0-84.9
0.3
Delta BMI (Kg/m2)
Mean±sd
Range
22.3±7.5
5.1-74.6
21.4±7.1
9.6-74.6
22.9±7.7
5.1-49.3
0.05
Intra-operation time (hr)
Mean±sd
Range
4.8±3.3
0.8-14.5
2.2±0.1
0.75-5.1
6.3±0.2
0.9-14.5
<0.0001
Any complication41.8%25.4%51.8%<0.0001
Dehiscence22.4%9.5%30.3%<0.0001
Seroma13.1%4.1%18.6%<0.0001
Cellulitis7.7%5.3%9.1%0.1
Necrosis
6.8%2.4%9.5%0.004
Hematoma
4.7%4.7%4.7%0.9
* Group I: single procedure, Group II: multiple procedure
P-values from t-test (continuous variables) or χ2 (categorical values) test for difference between groups

Table 2: Regression Analysis of Body Mass on Complication Development*



All Cases
OR (95% CI)

Group I
OR (95% CI)

Group II
OR (95% CI)
MaxBMI CurrentBMIΔBMI MaxBMI CurrentBMIΔBMI MaxBMI CurrentBMIΔBMI
Any Complication 1.17
(1.06, 1.29)
1.13
(0.94, 1.35)
1.22
(1.08, 1.38)
1.30
(1.08, 1.57)
1.45
(1.07, 1.95)
1.24
(0.99, 1.55)
1.12
(1.00, 1.26)
0.97
(0.77, 1.22)
1.21
(1.04, 1.40)
Dehiscence1.06
(0.95, 1.19)
1.20
(0.97, 1.48)
1.00
(0.87, 1.16)
1.21
(0.97, 1.50)
1.68
(1.14, 2.48)
1.05
(0.78, 1.43)
1.02
(0.90, 1.16)
1.05
(0.82, 1.35)
0.99
(0.85, 1.16)
Seroma 1.04
(0.92, 1.19)
0.84
(0.64, 1.12)
1.14
(0.98, 1.33)
1.06
(0.79, 1.41)
0.93
(0.53, 1.66)
1.12
(0.81, 1.56)
1.04
(0.90, 1.20)
0.82
(0.60, 1.13)
1.14
(0.95, 1.35)
Infection 1.25
(1.09, 1.45)
1.21
(0.90, 1.62)
1.30
(1.09, 1.55)
1.66
(1.18, 2.34)
1.74
(1.06, 2.84)
1.60
(1.14, 2.26)
1.12
(0.93, 1.35)
0.99
(0.67, 1.45)
1.19
(0.94, 1.49)
Necrosis 1.01
(0.84, 1.22)
0.68
(0.44, 1.05)
1.15
(0.93, 1.42)
0.87
(0.49, 1.55)
0.50
(0.16, 1.53)
1.02
(0.92, 1.13)
1.03
(0.85, 1.26)
0.72
(0.46, 1.15)
1.16
(0.92, 1.47)
Hematoma1.06
(0.86, 1.30)
1.01
(0.65, 1.56)
1.08
(0.85, 1.38)
0.89
(0.57, 1.39)
0.91
(0.45, 1.84)
0.90
(0.52, 1.55)
1.14
(0.90, 1.44)
1.16
(0.69, 1.95)
1.14
(0.85, 1.53)
Transfusion1.22
(1.06, 1.39)
1.09
(0.82, 1.46)
1.28
(1.08, 1.51)
1.31
(1.02, 1.69)
1.40
(0.84, 2.31)
1.33
(0.98, 1.79)
1.18
(1.00, 1.39)
0.99
(0.69, 1.40)
1.25
(1.02, 1.54)
* Multivariate logistic regression of the body mass index with a particular complication; odds ratios are for a 5 unit change; values in bold are significant (p<.05)
Results for all cases after adjusting for covariates from univariate analysis: study group (any complication, dehiscence, seroma, and necrosis models), gender (seroma and hematoma models) and gastric bypass (infection and necrosis models)

Figure 1. Predicted probability of developing complications over changing values of Maximum BMI by multivariate logistic regression model.