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Can We Use Nutrition as a Predictor? Preoperative Biomarkers and Wound Complications in Massive Weight Loss Patients
Meeti Mehta
*1, Adaora Okigbo
1, Aileen Cui
1, Jeffrey Gusenoff
2, J. Peter Rubin
21Department of Plastic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA; 2Department of Plastic Surgery, University of Pittsburgh, Pittsburgh, PA
Introduction
Chronic malnutrition is linked to wound complications after body contouring surgery in massive weight loss (MWL) patients, yet the impact of preoperative nutritional status is not well understood. This study assesses nutrition's predictive value for postoperative complications.
Methods
Panniculectomy patients from 2022-2024 were included. Clinical and preoperative nutrition data were collected. Infection, dehiscence, necrosis, seroma, or suture extrusion were classified as delayed wound healing. Multivariate regression was performed, controlling for confounders.
Results
172 patients were assessed. Preoperatively, patients exercised (51%) and supplemented (74%), with normal average labs. The complication rate was 46%, including wound dehiscence (12%), seroma (10%), and hematoma (8%).
Patients who routinely exercised (OR 0.11, p=0.02) or took supplements (OR 0.13, p=0.03) were less likely to have complications, while patients with greater preoperative BMI (OR 1.20, p=0.045) or anemia (OR 2.92, p=0.04) were more likely to have complications. Those with vitamin D deficiency also had increased complication risk (OR 4.81, p=0.005), including delayed wound healing (OR 4.19, p=0.01). Patients taking multivitamins had lower risk of delayed wound healing (OR 0.42, p=0.04).
Lower albumin levels increased risk of seroma (OR 25, p=0.02). Prolonged PTT (OR 1.28, p=0.048), or decreased sodium (OR 1.67, p=0.02) and bicarbonate levels (OR 1.72, p=0.04) increased the risk of wound dehiscence. Prolonged PT (OR 9.00, p=0.03), and elevated WBC count (OR 1.51, p=0.02) and calcium levels (OR 12.19, p=0.02) increased hematoma risk.
Conclusion
Preoperative nutritional status significantly impacts postoperative complications in panniculectomy patients. Nutritional biomarkers like albumin, sodium, bicarbonate, and coagulation factors were predictive of wound healing issues, while exercise and supplementation reduced complication risks. Targeted interventions based on nutritional assessment could improve outcomes and minimize postoperative complications in this patient population.
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