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Operative Duration, Not Procedural Combination, Drives Postoperative Morbidity in Body Contouring Surgery
Christina S. Chopra
*1, Uttsav Patel
3, Radhika Patel
3, Isha Joshi
1, Daniella Abramov
2, Tara L. Huston
11Division of Plastic Surgery, Stony Brook University Hospital, Stony Brook, NY; 2Surgery, New York-Presbyterian Queens, Queens, NY; 3Renaissance School of Medicine, Stony Brook University Hospital, Stony Brook, NY
IntroductionBody contouring procedures are often combined to reduce anesthetic exposures and recovery time. It remains unclear whether increased morbidity reflects intrinsic risk of combined procedures or longer operative duration. We hypothesized that operative time independently predicts 30-day morbidity and that procedural combination does not confer excess risk after adjustment.
MethodsNSQIP was queried for 45,288 patients undergoing body contouring. Multivariable logistic regression modeled operative time as a continuous variable. Outcomes included overall complications, SSI, reoperation, readmission, and dehiscence. Models were adjusted for demographics and procedure clusters. Interaction terms assessed whether risk differed by procedural combination. A sub-analysis compared isolated abdominoplasty versus abdominoplasty with liposuction (n=12,678).
ResultsAmong 22,530 patients in extreme operative quartiles, longer duration was associated with increased complications (p<0.001). Modeled continuously, operative time independently predicted morbidity in a linear fashion: each additional 30 minutes increased odds of any complication by 7%, SSI by 5%, readmission by 5%, and reoperation by 4% (p<0.001). In the abdominoplasty sub-analysis, combined cases had higher unadjusted complication rates; however, after adjustment, procedural combination was not independently associated with complications (p=0.079). The effect of operative duration was consistent across cohorts. Operative time remained predictive alongside smoking (OR 1.6), ASA ≥3 (OR 1.7), BMI (OR 1.026), and preexisting wound (OR 4.7) (all p<0.001).
ConclusionOperative duration is an independent, dose-dependent driver of morbidity in body contouring. In abdominoplasty, adding liposuction does not increase risk once operative time is considered. Increased complications in combined cases are attributable to operative length, not the combination itself. These findings support combined procedures when operative duration is appropriately managed, emphasizing efficiency and patient selection to optimize outcomes.
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