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Recent Weight Loss Identifies a Distinct Physiologic Vulnerability Phenotype in Body Contouring Surgery
Teresa Nam¹, Alexis Aparicio², Lokesh Patil³, Christina S. Chopra^*1, Isha Joshi¹, Tommaso A. addona^4
1Division of Plastic Surgery, Stony Brook University Hospital, Stony Brook, NY; ²Renaissance School of Medicine, Stony Brook University Hospital, Stony Brook, NY; ³OBGYN, Stony Brook University Hospital, Stony Brook, NY; ⁴New York Plastic Surgical Group, Garden City, NY

Background
An increasing number of patients present for body contouring following recent weight loss. This period may reflect physiologic stress, nutritional depletion, and comorbidity burden. However, the impact of recent weight loss (RWL) on postoperative outcomes remains poorly characterized. We hypothesized that RWL identifies a clinically distinct, higher-risk phenotype rather than serving as an isolated risk factor.

Methods
A retrospective analysis of the ACS NSQIP database (2012-2024) was performed for patients undergoing body contouring procedures. RWL was defined as >10% weight loss within 6 months. Patients were stratified by RWL status. Multivariable logistic regression assessed predictors of surgical site infection (SSI) and composite complications, adjusting for demographic and clinical covariates.

Results
Among 30,520 patients, 58 (0.19%) met criteria for RWL. These patients demonstrated a distinct comorbidity profile with higher rates of frailty, hypoalbuminemia, steroid use, and hypertension (p<0.05), consistent with increased physiologic vulnerability. RWL was associated with higher observed rates of adverse outcomes. In adjusted analysis, RWL was not independently associated with SSI (p=0.38), while age and BMI remained significant predictors. No interaction between RWL and BMI was observed. However, RWL remained independently associated with composite morbidity (OR 2.88, p<0.001).

Conclusion
Recent weight loss identifies a small, clinically distinct subgroup characterized by frailty, nutritional compromise, and increased comorbidity burden. While not independently associated with SSI, this phenotype is associated with increased postoperative morbidity. These findings suggest that RWL may serve as a marker of physiologic vulnerability rather than a direct driver of complications. Given its low prevalence and heterogeneity in NSQIP, these results are hypothesis-generating and support incorporating broader markers of frailty and metabolic stress into preoperative risk assessment.
Comparison of Unadjusted Postoperative Outcomes in Patients With and Without Recent Weight Loss

Outcome	No RWL (n=20,674)	RWL (n=58)	p-value
SSI	6.7%	13.8%	0.033
Wound dehiscence	1.1%	6.9%	<0.001
Reoperation	4.0%	8.6%	0.072
Readmission	5.7%	15.5%	0.001
VTE	1.0%	6.9%	<0.001
Composite Complications	12.2%	29.3%	<0.001

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