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Reischies FMJ, Tiefenbacher F, Holzer-Geissler JCJ, Wolfsberger C, Eylert G, Mischitz M, Pregartner G, Meikl T, Winter R, Kamolz LP, Lumenta DB. BMI and Revision Surgery for Abdominoplasties: Complication Definitions Revisited Using the Clavien-Dindo Classification. Plast Reconstr Surg Glob Open 2023; 11:e4411. [PMID: 36798721 PMCID: PMC9925103 DOI: 10.1097/gox.0000000000004411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Accepted: 04/12/2022] [Indexed: 02/15/2023]
Abstract
After body contouring surgery of the lower trunk (CSLT), the definition, rate (4%-70%), and documentation of complications vary. Objectives We analyzed the effect of risk factors on the outcome based on the Clavien-Dindo classification (CDC) after CSLT surgery and polled postoperative satisfaction among patients. Methods All patients undergoing CSLT from 2001 to 2016 were included and were classified according to the CDC for postoperative events. Statistical analysis included proportional odds logistic regression analysis. We polled patients to grade their satisfaction with the postoperative result and whether they would have the operation performed again. Results A total of 265 patients were included: 60 (22.6%), 25 (9.4%), 28 (10.6%), and 21 (7.9%) were in CDC grades I, II, IIIa, and IIIb, respectively. A high preoperative body mass index significantly increased the odds for a postoperative event requiring revision surgery under general anesthesia (CDC grade IIIb, odds ratio 0.93, 95% confidence interval 0.89-0.97, P = 0.001). One-hundred twenty-eight patients (48.3%) participated in the poll: 101 (78.9%) were either happy or content with the postoperative results, and 117 (91.4%) would have the procedure performed again, including all nine patients with CDC grade IIIb. Conclusions Our results confirm that a high body mass index is a statistically significant risk factor for requiring major revision surgery after CSLT. Despite being a complication prone intervention, postoperative satisfaction after CSLT was ranked favorably in our sample. We recommend that the CDC be used in all surgical specialties to evaluate complications and permit future comparability of pooled data.
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Affiliation(s)
- Frederike M. J. Reischies
- From the Research Unit for Tissue Regeneration, Repair and Reconstruction, Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
| | - Fabian Tiefenbacher
- From the Research Unit for Tissue Regeneration, Repair and Reconstruction, Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
| | - Judith C. J. Holzer-Geissler
- From the Research Unit for Tissue Regeneration, Repair and Reconstruction, Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria,COREMED—Cooperative Centre for Regenerative Medicine, Joanneum Research Forschungsgesellschaft mbH, Graz, Austria
| | - Christina Wolfsberger
- From the Research Unit for Tissue Regeneration, Repair and Reconstruction, Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria,Division of Neonatology, Department of Pediatric and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - Gertraud Eylert
- From the Research Unit for Tissue Regeneration, Repair and Reconstruction, Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
| | - Madeleine Mischitz
- From the Research Unit for Tissue Regeneration, Repair and Reconstruction, Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
| | - Gudrun Pregartner
- Institute for Medical Informatics, Statistics und Documentation, Medical University of Graz, Graz, Austriaand
| | - Tobias Meikl
- Department of Surgery, St John of God Hospital, Graz, Austria
| | - Raimund Winter
- From the Research Unit for Tissue Regeneration, Repair and Reconstruction, Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
| | - Lars-Peter Kamolz
- From the Research Unit for Tissue Regeneration, Repair and Reconstruction, Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria,COREMED—Cooperative Centre for Regenerative Medicine, Joanneum Research Forschungsgesellschaft mbH, Graz, Austria
| | - David B. Lumenta
- From the Research Unit for Tissue Regeneration, Repair and Reconstruction, Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
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Clinical Outcomes of Single Versus Double Anaerobic Coverage for Intra-abdominal Infections. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2022. [DOI: 10.1097/ipc.0000000000001175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Cinclair R, Shang Z, Aly A, Kenkel J. The Impact of Comorbidities on Patient Outcomes in the Upper Body Lift: A Retrospective Review. Aesthet Surg J Open Forum 2022; 4:ojac063. [PMID: 36128596 PMCID: PMC9475277 DOI: 10.1093/asjof/ojac063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background Nonsurgical and surgical weight loss options have improved over the past several decades resulting in an increased number of patients who present with body contour deformities. This review focuses on the upper truncal deformity. This deformity is discernable by its residual tissue laxity in the upper arm, back, lateral chest, and breast. Objective The purpose of this study is to evaluate the morbidity of this procedure when these regions are treated in one operative setting. Methods A retrospective chart review of patients who underwent an upper body lift for truncal deformities after massive weight loss by the senior author between August 2006 and December 2019 was performed. Patient comorbidities and demographics, preoperative parameters, operative factors, and minor and major complications were assessed. Results No intraoperative or major complications occurred. The overall complication rate was 71% (20/28), which were all minor and most related to wound breakdown. Using logistical regression analysis, we found that neither BMI nor amount of weight resected contributed to a higher complication rate in this cohort. Simple matching coefficients analysis identified anemia, hypertension, lifetime smoking history, celecoxib use, and multiple concurrent procedures as comorbidities and intraoperative factors with an increased risk for adverse outcomes. Conclusions This review helps define the role of upper body lift in the care of patients with massive weight loss and addresses the morbidity of a comprehensive approach to upper body deformity. Appropriate patient selection, preoperative patient counseling, sound operative technique, and supportive postoperative care can help to avoid adverse outcomes. Level of Evidence 4
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Affiliation(s)
- Richard Cinclair
- Corresponding Author: Mr Richard Cinclair III, Department of Plastic Surgery, University of Texas Southwestern, 1801 Inwood Road 5th Floor, Dallas, TX 75390, USA. E-mail: ; Instagram: @treycinclair
| | - Zhiguo Shang
- Department of Bioinformatics, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Al Aly
- Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA; and a body contouring section editor for Aesthetic Surgery Journal
| | - Jeffrey Kenkel
- Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA; editor-in-chief of ASJ Open Forum; and associate editor of Aesthetic Surgery Journal
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Simunovic F, Bonaventura B, Schneider L, Horner VK, Weber J, Stark GB, Kalash Z. The Edmonton Obesity Staging System Predicts Postoperative Complications After Abdominoplasty. Ann Plast Surg 2021; 87:556-561. [PMID: 34699434 DOI: 10.1097/sap.0000000000002814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND This study investigates the relationship between Edmonton Obesity Staging System (EOSS) and the occurrence of postoperative complications after abdominoplasty in massive weight loss patients. METHODS A single-institution retrospective review of patients undergoing abdominoplasty between 2009 and 2019 after massive weight loss. Demographic data, laboratory findings, known risk factors for postoperative complications, as well as data on major and minor complications were extracted from the patient charts. Logistic regression models were used to investigate the relationship between the variables. RESULTS Four hundred and five patients were included in the study. The prevalence of EOSS stages was: 0 (no comorbidities, N = 151, 37%), 1 (mild conditions, N = 40, 10%), 2 (moderate conditions, N = 149, 36%) and 3 (severe conditions, N = 70, 17%). Regression analysis showed that, controlling for body mass index (BMI), BMI Δ (maximal BMI - BMI at presentation), bariatric surgery, volume of resected tissue, and duration of surgery, EOSS stage significantly associated with the occurrence of postoperative complications. Compared with EOSS stage 0, EOSS stages 2 and 3 patients were associated with significantly more minor and major complications, respectively. The volume of resected tissue, BMI Δ, and age were associated with the occurrence of major complications. A regression model of comorbidities comprising the EOSS revealed a significant association of variables diabetes mellitus and hypertension with the occurrence of postoperative complications. CONCLUSIONS Edmonton Obesity Staging System is a robust predictor of postoperative complications in abdominoplasty.
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Affiliation(s)
- Filip Simunovic
- From the Department of Plastic and Hand Surgery, Freiburg University Medical Center, Freiburg, Germany
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Montemurro P, Cheema M, Hedén P. In search for the 'perfect' breast implant: are textured implants still indicated in today's breast augmentation practice? J Plast Surg Hand Surg 2021; 55:302-308. [PMID: 33612069 DOI: 10.1080/2000656x.2021.1883630] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The popularity of breast augmentation procedure has driven research and debate as to whether any given implant characteristic offers a functional advantage. One such debate exists about the role of surface texturing. In the aftermath of the recent withdrawal of aggressively textured surfaces we would like to summarize the first author's experience of nearly 1500 primary aesthetic breast augmentations with different surfaces and offer our thoughts on this topic. All consecutive primary breast augmentations operated by the first author from January 2010 to June 2019 were included. All patients had silicone implants inserted via inframammary incision. Of all the operated cases, 1029 consecutive female patients had at least 6 months' follow-up (mean 15.1 months). Their mean age was 31.2 years, mean BMI 20.8 kg/m2 and mean implant volume was 311 cc. 997(96.9%) patients had dual plane and 32(3.1%) had sub-glandular implant placement. In total 113 patients (11.0%) developed a complication. This represented 15.1% of those with round and 10.0% of anatomical shape (or 10.6% of textured and 14.5% of smooth surface implants). As clinicians, we like patients to receive all the advantages of an implant but not be exposed to any risks. However, in reality, such a 'perfect implant' still does not exist. New literature continues to shed light on this trade-off between an implant's perceived utility and its complications profile. We hope that the search for an alternative technology, with more beneficial surface characteristics and less drawbacks, continues.
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Affiliation(s)
| | - Mubashir Cheema
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
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Bunting H, Lu KB, Shang Z, Kenkel J. Vertical Abdominoplasty Technique and the Impact of Preoperative Comorbidities on Outcomes. Aesthet Surg J Open Forum 2020; 3:ojaa043. [PMID: 33791664 PMCID: PMC7891258 DOI: 10.1093/asjof/ojaa043] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background As the number of patients requiring bariatric surgery has increased, so has the demand for body contouring after massive weight loss. Surgery involving the abdomen in these patients is particularly challenging as both vertical and horizontal laxity if often present, making traditional abdominoplasty techniques less effective. Objectives The aim of this study was to review the operative technique and evaluate the preoperative comorbidities and operative decisions that may impact patient outcomes in those undergoing vertical abdominoplasty. Methods A review of the authors' technique is described. A retrospective chart review of patients who underwent vertical abdominoplasty for significant vertical and horizontal laxity after massive weight loss by a single surgeon between June 2007 and July 2019 was performed. Preoperative parameters, operative factors, and minor and major complications were evaluated. Results Our complication rate was 81% (13/16), which were all minor. No major complications were encountered. Patients with a history of nicotine use had a 100% complication rate. There was a trend toward higher seroma formation in patients with coronary artery disease and those with a history of smoking. There was also a trend toward higher wound dehiscence in patients with renal disease. The authors found no statistically significant correlation between complications and older age, higher weight of tissue resected, higher body mass index, and medical comorbidities. Conclusions This small series helps to elucidate the role of vertical abdominoplasty in the care of patients following massive weight loss and its associated morbidity. Proper patient selection, appropriate preoperative patient counseling, and sound surgical technique help to mitigate the negative outcomes. Level of Evidence 4
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Affiliation(s)
- Haley Bunting
- Department of Plastic Surgery and the Lyda Hill Department of Bioinformatics, University of Texas Southwestern, Dallas, TX
| | - Karen B Lu
- Department of Plastic Surgery and the Lyda Hill Department of Bioinformatics, University of Texas Southwestern, Dallas, TX
| | - Zhiguo Shang
- Department of Plastic Surgery and the Lyda Hill Department of Bioinformatics, University of Texas Southwestern, Dallas, TX
| | - Jeffrey Kenkel
- Department of Plastic Surgery and the Lyda Hill Department of Bioinformatics, University of Texas Southwestern, Dallas, TX
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Rubio GA, Mundra LS, Thaller SR. Association of Autoimmune Connective Tissue Disease With Abdominoplasty Outcomes: A Nationwide Analysis of Outcomes. JAMA Surg 2019; 153:186-188. [PMID: 29094151 DOI: 10.1001/jamasurg.2017.3796] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Gustavo A Rubio
- DeWitt Daughtry Family Department of Surgery, University of Miami Leonard M. Miller School of Medicine, Miami, Florida
| | - Leela S Mundra
- University of Miami Leonard M. Miller School of Medicine, Miami, Florida
| | - Seth R Thaller
- Division of Plastic, Aesthetic, and Reconstructive Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami Leonard M. Miller School of Medicine, Miami, Florida
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Augustine HFM, Hu J, Najarali Z, McRae M. Scoping Review of the National Surgical Quality Improvement Program in Plastic Surgery Research. Plast Surg (Oakv) 2019; 27:54-65. [PMID: 30854363 DOI: 10.1177/2292550318800499] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Background The National Surgical Quality Improvement Program (NSQIP) is a robust, high-quality surgical outcomes database that measures risk-adjusted 30-day outcomes of surgical interventions. The purpose of this scoping review is to describe how the NSQIP is being used in plastic surgery research. Methods A comprehensive electronic literature search was completed in PubMed, Embase, MEDLINE, and CINAHL. Two reviewers independently reviewed articles to determine their relevance using predefined inclusion criteria. Articles were included if they utilized NSQIP data to conduct research in a domain of plastic surgery or analyzed surgical procedures completed by plastic surgeons. Extracted information included the domain of plastic surgery, country of origin, journal, and year of publication. Results A total of 106 articles met the inclusion criteria. The most common domain of plastic surgery was breast reconstruction representing 35% of the articles. Of the 106 articles, 95% were published within the last 5 years. The Plastic and Reconstructive Surgery journal published most of the (59%) NSQIP-related articles. All of the studies were retrospective. Of note, there were no articles on burns and only one study on trauma as the domain of plastic surgery. Conclusion This scoping review describes how NSQIP data are being used to analyze plastic surgery interventions and outcomes in order to guide quality improvement in 106 articles. It demonstrates the utility of NSQIP in the literature, however also identifies some limitations of the program as it applies to plastic surgery.
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Affiliation(s)
- Haley F M Augustine
- Department of Plastic Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Jiayi Hu
- Department of Plastic Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Zainab Najarali
- Department of Family Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Matthew McRae
- Department of Plastic Surgery, McMaster University, Hamilton, Ontario, Canada
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Johnson SP, Swiatek PR, Wang L, Liu M, Chung TT, Chung KC. Risk Factors for Undergoing Elective Abdominal Contouring Surgery Shortly After Hospitalization. J Surg Res 2019; 236:51-59. [PMID: 30694779 DOI: 10.1016/j.jss.2018.11.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Revised: 09/26/2018] [Accepted: 11/09/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND Having posthospital syndrome (PHS) at the time of an elective surgery increases the risk of postoperative adverse outcomes. The purpose of this article was to identify incidence and risk factors for having PHS at the time of abdominal contouring surgeries. METHODS Insurance claims from the Truven MarketScan Databases were used to identify patients who underwent outpatient abdominoplasty, liposuction, or panniculectomy between April 2010 and August 2015. Patients were presumed to have PHS if they were hospitalized within 90 d before surgery. Incidence rates of having PHS were calculated for patient groups defined by demographic data and comorbidities. Statistical inference based on adjusted odds ratios was used to evaluate the association of potential risk factors with PHS. A nonparametric regression method was used to demonstrate nonlinear effects of patient covariates on the risk of PHS. RESULTS This study included 18,947 patients who underwent abdominal contouring; 77% were female, and the mean age was 48.7 y (SD = 14.7). Six percent (n = 1045) of patients had PHS at the time of surgery. A significantly stronger association with PHS (P < 0.001) was observed in patients with deep venous thrombosis (adjusted odds ratio = 3.56), Elixhauser score > 8 (3.28), and smokers (2.16). Age was found to have a piecewise linear effect on PHS, with odds increasing by 2.1% per year over the age of 45 y. CONCLUSIONS Older patients have an increased risk of undergoing abdominal contouring surgery in a deconditioned state. Screening at-risk populations for PHS would help identify patients who need rehabilitation before operative intervention.
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Affiliation(s)
- Shepard P Johnson
- Plastic and Reconstructive Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | | | - Lu Wang
- Department of Biostatistics, University of Michigan, Ann Arbor, Michigan
| | - Mochuan Liu
- Department of Statistics, University of Michigan, Ann Arbor, Michigan
| | - Ting-Ting Chung
- Center for Big Data Analytics and Statistics, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Kevin C Chung
- Department of Surgery, Section of Plastic Surgery, Assistant Dean for Faculty Affairs, University of Michigan Medical School, Ann Arbor, Michigan.
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