Outcomes for Cosmetic and Reconstructive Surgeries of the Periorbital Complex from the “Tracking Operations and Outcomes for Plastic Surgeons” Database

Abstract

GOALS/PURPOSE: Eyelid surgery for both aesthetic and reconstructive purposes are common plastic surgery procedures. However, there is a paucity of data from multi-institutional studies with large sample sizes. The purpose of this study was to utilize a national database and perform a comprehensive analysis of surgical outcomes for blepharoplasty. METHODS/MATERIALS: This is a retrospective cohort review from 2003 to 2018 using the Tracking Operations and Outcomes for Plastic Surgeons database. The dataset was evaluated using Current Procedural Terminology codes for blepharoplasties and its related procedures (15820, 15821, 15822, 15823). These codes correspond to lower eyelid blepharoplasty, lower with extensive herniated fat pad, upper eyelid blepharoplasty, and upper with excessive skin weighting down. The core groups analyzed are those with upper, lower, or combined blepharoplasties. Categorical variables are described as frequencies and compared with Fisher exact or Pearson chi-squared test. Continuous variables, based on normality, are described as means (SD) or medians (IQR) and compared with Student T or Wilcoxon Rank-sum test, respectively. A stepwise backward multivariate logistic regression analysis was performed to assess the effect size of risk factors for adverse events with a P value set at 0.05 for significance. RESULTS/COMPLICATIONS: A total of 20,275 eyelid procedures were included. Mean age was 54.7 years (SD 12.26), female rate was 86.2% (17,466), and mean BMI was 24.77 (SD 5.65). In demographics and comorbidities, 68.4% were Whites, followed by Asians (8.7%), diabetes rate was 2.9%, and 5.9% were smokers. We analyzed 15,720 (77.5%) upper and 13,359 (65.9%) lower eyelids; of those, 8804 (43.4%) were combined. The complication rate was 2.47% for upper, 3.97% for lower eyelid, and 4.68% for combined. Comparing combined blepharoplasties to single eyelid, there was a statistically significant higher rate of hematoma (P < 0.001) eyelid malposition/asymmetry (P = 0.004) and chemosis (P < 0.001) in the combined group. For lower eyelid blepharoplasty, ectropion was more common compared with combined (P < 0.001). On the multivariate regression analysis, combined blepharoplasty (OR 1.49 95%CI 1.08–2.08; P = 0.01), performing over three procedures at the same case (OR 1.80 95%CI 1.34–2.41; P < 0.001), and Hispanic ethnicity (OR 3.1 95%CI 1.17–8.21; P = 0.02) were associated with a higher likelihood to have complications. However, being a non-tobacco smoker (OR 0.56 95%CI 0.36-–0.86; P = 0.009) lowers that probability by 44%. CONCLUSIONS: The results from this study provide insight into the national complication rate for blepharoplasty to be up to 4%, with hematoma and return to the OR as the most common. Risk factors identified for developing complications are performing a combined upper and lower blepharoplasty, having over three procedures at the same time and being of Hispanic ethnicity, while no history of smoking was associated with a decreased probability for morbidity.