Risk of Complications in Combined Plastic Surgery Procedures Using the Tracking Operations and Outcomes for Plastic Surgeons Database.

Abstract

Combining multiple surgical procedures into one operative session is widespread in the field of plastic surgery; however, the implications of this practice are not fully understood. This study compared 30-day complication rates associated with combined plastic surgery procedures compared to index procedures. This retrospective cohort analysis utilized the Tracking Operations and Outcomes for Plastic Surgeons database from 2016-2020 to identify the three most frequent combinations with augmentation mammaplasty, reduction mammaplasty, trunk liposuction, mastopexy, and abdominoplasty. The 30-day overall complication rate was 5.0% (1,400 of 26,771 patients), with a higher complication rate for combined procedures compared to index (7.6% vs 4.2%, aOR 1.91 (95% CI 1.61-2.27), p<0.001). There were no significant differences in complication rates for abdominoplasty or mastopexy combinations compared to index. Complication rates for reduction mammaplasty combinations compared to index were not statistically different after controlling for demographics (aOR 1.02 (95% CI 0.61, 1.64) p=0.93). Higher rates of minor and major complications were observed for combinations of trunk liposuction (aOR 4.84, (95% CI 3.31, 7.21), p<0.001) and augmentation mammaplasty (aOR 1.60, (95% CI 1.13, 2.22), p=0.007) compared to index. TOPS data suggests that combinations with trunk liposuction or augmentation mammaplasty present with increased risk of complications compared to index, controlling for demographics. Abdominoplasty and mastopexy may be combined with other plastic surgery procedures without increased risk to patients. The complication risk of reduction mammaplasty combinations is mediated by other variables, suggesting the need for shared surgical decision making when recommending these combinations to patients.