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Revision Rates in Massive Weight Loss Body Contouring: Incidence and Predictors
Russell E. Kling, BA1, Ronald P. Bossert, MD2, Devin Coon, MD3, Jacqueline Bliley, MS1, Patrick Emelife, BA1, Jeffrey A. Gusenoff, MD1, J Peter Rubin, MD1.
1University of Pittsburgh, Pittsburgh, PA, USA, 2University of Rochester, Rochester, NY, USA, 3Johns Hopkins University, Baltimore, MD, USA.

Background The need for surgical revision in body contouring surgery is not well described. Minimizing revision rates in body contouring surgery following massive weight loss is important in order to increase patient satisfaction and decrease morbidity and associated health care costs. The authors sought to examine factors predicting higher rates of revision following body contouring surgery after massive weight loss.
Methods Four hundred seventy one massive weight loss patients underwent body contouring surgery. All revision surgeries took place between 2003 and 2012 and were performed by the senior author at the University of Pittsburgh. Revision procedures were separated into ten major surgical categories. Complications were examined based on the need for operative management. Demographic information, including age, sex, method of weight loss, body mass indices, and co-morbidities was included for analysis. A comparative outcomes analysis between subjects requiring revision body contouring surgery and subjects not requiring revision body contouring surgery was performed (Stata/SE version 10.1).
Results Abdominal contouring surgery was the most common revision procedure with an 8% occurrence rate (n=37). There was no association between the frequency of revisions needed and the following risk factors: age, gender, BMI indices, co-morbidities, smoking status, anticoagulant use or average daily pre-operative protein intake (p<0.05). Diet and exercise patients required more revision procedures than surgical weight loss patients (27% vs.17%; p=0.025). Patients undergoing multiple procedures in a single setting were more likely to require a revision (p=0.03). The revision rate nearly doubled from 17% to 32% if there was a complication in the immediate post-operative period, regardless of whether it required operative management (p=0.003).
Conclusion Patients should be advised that although the revision rates are relatively low and not correlated with most surgical risk factors, it is associated with postoperative complications and in cases with multiple procedures. Self-weight loss patients, who often have multiple procedures performed at once, were at higher risk as well. Careful surgical planning and staging may avoid need for revision surgery.


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