Complications in Body Contouring

Abstract

INTRODUCTION: Body contouring is a rapidly emerging field in plastic surgery and the literature is becoming ripe with retrospective reviews of outcomes, but there is limited data from prospective registries regarding the 30-day morbidity in larger cohorts. Evidence-based interventions, risk stratification, and patient selection and counseling can be enhanced through critically assessing national outcome data. This study characterizes the overall incidence and risk factors associated with wound complications, major morbidity, and medical complications using a large, prospective dataset. METHODS: We retrospectively reviewed the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database (http://www.acsnsqip.org/) from 2005 to 2010 for all body contouring cases, including CPT codes brachioplasty, medial thigh lift, abdominoplasty, and suction assisted lipectomy (SAL). Outcomes assessed included wound complications (please define), major morbidities (please define), and medical complications. RESULTS: Seventeen hundred ninety seven patients underwent body contouring during the study period, the vast majority were female (n=1600, 89.0%). Average BMI of patients undergoing body contouring was 31.6, with a total of 239 morbidly obese individuals (BMI ³ 40kg/m2). The most common area of intervention was the trunk region, with 1,652 (91.9%) patients receiving abdominal contouring and/or contouring of the hips and buttocks. Breast contouring was performed in 254 (14.1%) patients, and contouring of the extremities in only 35 (2.0%). A total of 179 (10.0%) patients underwent suction-assisted-lipectomy as part of the contouring regiment. Just under half of the procedures (n=834, 46.4%) were performed in the in-patient settings. While the majority of patients underwent only one contouring procedure (n=1,478, 82.3), 271 (15.1%) underwent 2 procedures, and 43 (2.4%) underwent 3. Wound complications occurred in 114 (6.3%) individuals, while 122 (6.8%) patients suffered from a major morbidity, and 40 (2.2%) experienced a medical complication. Multivariate logistic regression revealed, the presence of multiple comorbidities (p=0.014, OR 15.87), presence of a bleeding disorder (p=0.026, OR 20.31), preoperative albumin level (p=0.003, OR 0.14), and malnutrition (p=0.065, OR 0.19), were associated with an increased odds of wound complication. In-patient procedures (p=0.06, OR 4.64), and functional status (p=0.011, OR 9.71) were associated with an increased odds of major surgical morbidity. Lastly, BMI (p=0.03, OR 1.06), the presence of a bleeding disorder (p=0.017, OR 17.16), and preoperative albumin levels (p=0.043, OR 0.20), were associated with increased odds of medical complications. CONCLUSION: This study characterizes the rate of wound complications, major morbidities, and medical complications in patients undergoing body contouring procedures using a large prospective, validated national data set. To the best of our knowledge it represents the largest body contouring outcome study to date. We show a wound complication rate of 6.3%, a major morbidity rate of 6.8%, and a medical complication rate of 2.2%. Importantly, several patient-related factors were shown to influence the risk of complication, including preoperative albumin, BMI, bleeding disorder, and functional status. These findings highlight the critical importance of careful preoperative patient evaluation, including laboratory screening, and underscores the need for detailed patient counseling and risk stratification.