Effect of Elevated Body Mass on Surgical Complications in Patients Undergoing Body Contouring After Massive Weight Loss
Pooja Humar*, Joseph Mocharnuk, Anne E. Glenney, Malke Asaad, Jeffrey Gusenoff, Peter Rubin
Department of Plastic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA
Patients undergoing massive weight loss are often left with whole body deformities that can be addressed with body contouring. As with any surgical procedure, assessment of patient risk is crucial. In this study we analyze the impact of prebariatric BMI, postbariatric BMI, and change in BMI on post weight loss reconstructive surgery outcomes.
942 patients who underwent body contouring from 2002-2018 after massive weight loss, defined as losing >50 pounds, were retrospectively reviewed. Body contouring procedures of the breast, thighs, buttock, arms, and abdomen were included. Variables of interest include medical comorbidities, post-operative complications, and number of procedures per case.
In this cohort, 942 patients undergoing massive weight loss, underwent 1063 cases involving 1814 procedures. Patients had a mean age of 48.9yrs ± 13.5yrs; 93.8% of patients were female. Mean pre-weight loss BMI, or maximum BMI, was 51.9 ± 9.8 while the mean post weight loss BMI was 30.5 ± 6.0. The change in BMI represents an average weight loss was 131.2lbs ± 51.5lbs. 424 patients (45.1%) had at least one post-operative complication, with skin necrosis and wound dehiscence being the most common Both increased Max BMI and increased Current BMI were associated with an increased incidence of complications (p<0.01). Current BMI increased the risk of post-operative skin necrosis (p<0.01) while a one point increase in max BMI was associated with a 2.0% increase risk in seroma formation (p<0.01) and 2.4% increase risk of wound dehiscence (p<0.05). In a subset analysis by number of surgical procedures, total number of complications was significantly higher in patients receiving multiple procedures (p<0.01) compared to single procedure cases.
Body mass indices influence complications in postbariatric reconstructive surgery. Both pre and post weight loss BMIs play a role in complication rate and type while the change in BMI did not. Careful patient selection, assessment of surgical complexity, and recognition of medical comorbidities can help to optimize outcomes after body contouring.
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