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Beyond BMI: A Physiologic Model Better Predicts Wound Complications After Body Contouring Surgery
Kyle Anderman
1, Lokesh Patil
2, Christina S. Chopra
*3, Isha Joshi
3, Tommaso A. addona
41Renaissance School of Medicine, Stony Brook University Hospital, Stony Brook, NY; 2OBGYN, Stony Brook University Hospital, Stony Brook, NY; 3Division of Plastic Surgery, Stony Brook University Hospital, Stony Brook, NY; 4New York Plastic Surgical Group, Garden City, NY
Background: Body contouring after massive weight loss carries high wound complication risk, making accurate preoperative risk assessment essential. BMI is commonly used to guide patient selection, yet it incompletely captures physiologic vulnerability and comorbidity burden. We evaluated whether a comorbidity-based physiologic model better predicts postoperative wound complications compared to BMI alone.
Methods: Adult patients undergoing panniculectomy, abdominoplasty, thighplasty, or brachioplasty were identified in the ACS NSQIP database from 2017 to 2024. The primary outcome was 30-day wound complication (SSI or dehiscence). Multivariable logistic regression models included a BMI-only model and a physiologic model incorporating BMI, ASA ≥3, CHF, steroid use, diabetes, smoking, and inpatient status. Model performance was assessed using area under the curve (AUC), Brier score, and net reclassification improvement (NRI), with 10-fold cross-validation.
Results: Among 29,379 patients included in our analysis, 7.4% developed postoperative wound complications. In the BMI-only model, BMI was associated with wound complications (OR 1.05 per unit, p<0.001). The physiologic model demonstrated improved discrimination (AUC 0.678 vs 0.656), improved risk classification (NRI 0.137), and higher identification of high-risk patients (67.8% vs 65.6%), with similar calibration (Brier 0.0657 vs 0.0665). Improvements were driven by incorporation of comorbidity burden rather than BMI alone.
Conclusion: BMI alone has limited ability to stratify risk in body contouring patients. A physiologic model incorporating comorbidities more accurately identifies patients at risk for wound complications. This supports moving beyond BMI-based thresholds toward more comprehensive, physiology-driven patient selection.
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