Low Complication Rates Using Closed-Incision Negative-Pressure Therapy for Panniculectomies: A Single-Surgeon, Retrospective, Uncontrolled Case Series

The Impact of Body Mass Index on Adverse Outcomes Associated with Panniculectomy: A Multimodal Analysis

BACKGROUND

Overhanging pannus may be detrimental to ambulation, urination, sexual function, and social well-being. Massive weight loss patients often have high residual body mass index (BMI) and comorbidities presenting a unique challenge in panniculectomy patient selection. This study aims to better characterize the role of BMI in postoperative complications following panniculectomy.

METHODS

A meta-analysis attempted to assess the impact of BMI on complications following panniculectomy. Cochrane Q and I2 test statistics measured study heterogeneity, with subsequent random effects meta-regression investigating these results. After this, all panniculectomy patients in the National Surgical Quality Improvement Program database in the years 2007 to 2019 were analyzed. Univariate and multivariable tests assessed the relative role of BMI on 30-day postoperative complications.

RESULTS

Thirty-four studies satisfied inclusion criteria, revealing very high heterogeneity (Cochrane Q = 2453.3; I2 = 99.1%), precluding further meta-analysis results. Receiver operating characteristic curves demonstrated BMI was a significant predictor of both all causes (area under the curve, 0.64; 95% CI, 0.62 to 0.66) and wound complications (area under the curve, 0.66; 95% CI, 0.63 to 0.69). BMI remained significant following multivariable regression analyses. Restricted cubic spines demonstrated marginal increases in complication incidence above 33.2 and 35 kg/m 2 for all-cause and wound complications, respectively.

CONCLUSIONS

Reported literature regarding postoperative complications in panniculectomy patients is highly heterogeneous and may limit evidence-based care. Complication incidence positively correlated with BMI, although the receiver operating characteristic curve demonstrated its limitations as the sole predictive variable. Furthermore, restricted cubic splines demonstrated diminishing marginal predictive capacity of BMI for incremental increases in BMIs above 33.2 to 35 kg/m 2 . These findings support a reevaluation of the role of BMI cutoffs in panniculectomy patient selection.

Closed Incision Negative Pressure Therapy Versus Traditional Dressings for Low Transverse Abdominal Incisions Healing by Primary Closure: A Systematic Review and Meta-Analysis

Background: Closed incision negative pressure therapy (ciNPT) devices may reduce wound healing complications when applied to closed surgical incisions. The aim of this review was to assess the effects of ciNPT versus standard dressings in patients undergoing primary closure of high tension, lower transverse abdominal incisions. Methods: This review was registered a priori on PROSPERO (CRD42021252048). A search of the following databases was performed in February 2021: Medline, EMBASE, and CENTRAL. Unpublished trials were searched using clinicaltrials.gov. All randomized and nonrandomized studies comparing ciNPT to standard dressings were included. Two independent reviewers performed screening and data extraction. Outcomes evaluated the incidence of wound dehiscence, surgical site infection, total abdominal complications, time to drain removal, and seroma formation. Main Results: Ten studies were included in quantitative and narrative synthesis. Observational study evidence suggests ciNPT likely reduces the incidence of wound dehiscence (odds ratio [OR] 0.57 [0.44-0.96], P = .03) and total abdominal complications (OR 0.34 [0.21-0.54], P < .01). Decreased incidence of seroma formation favored ciNPT (OR 0.65 [0.24-1.76], P = .40); however, this did not achieve significance. Randomized and non-randomized study evidence was very uncertain about the effect of ciNPT on the remaining outcomes. Conclusions: The current best randomized study evidence is very uncertain about the effect of ciNPT on these outcomes. Observational study evidence suggests ciNPT likely results in a statistically significant reduction in abdominal wound dehiscence and total abdominal complications. Additional randomized trials are warranted to limit the impact of bias on the overall certainty of the evidence.

Negative Pressure Wound Therapy After Abdominal Body Contouring: A Comparative Matched Analysis of Outcomes and Cost

Background: Studies that have previously validated the use of incisional negative pressure wound therapy (iNPWT) after body contouring procedures (BCP) have provided limited data regarding associated health care utilization and cost. We matched 2 cohorts of patients after BCP with and without iNPWT and compared utilization of health care resources and post-operative clinical outcomes. Methods: Adult patients who underwent abdominoplasty and/or panniculectomy between 2015 and 2020 by a single surgeon were identified. Patients were propensity score matched by body mass index (BMI), gender, smoking history, diabetes mellitus, hypertension, and incision type. Primary outcomes included time to final drain removal, outpatient visits, homecare visits, emergency department visits, and cost. Secondary outcomes included surgical site occurrences (SSO), surgical site infections, reoperations, and revisions. Results: One hundred sixty-six patients were eligible, and 40 were matched (20 with iNPWT and 20 without iNPWT) with a median age of 47 years and BMI of 32 kg/m2. There were no differences in demographics or intraoperative details (all P > .05). No significant differences were found between the cohorts in terms of health care utilization measures or clinical outcomes (all P > .05). Direct cost was significantly greater in the iNPWT cohort (P = .0498). Inpatient length of stay and procedure time were independently associated with increased cost on multivariate analysis (all P < .0001). Conclusion: Consensus guidelines recommend the use of iNPWT in high-risk patients, including abdominal BCP. Our results show that iNPWT is associated with equivalent health care utilization and clinical outcomes, with increased cost. Additional randomized controlled trials are needed to further elucidate the cost utility of this technique in this patient population.

Negative Pressure Wound Therapy Prevents Hernia Recurrence in Simultaneous Ventral Hernia Repair and Panniculectomy

Simultaneous ventral hernia repair with panniculectomy (VHR-PAN) is associated with a high rate of wound complications. Closed incision negative pressure wound therapy (ciNPWT) has been shown to lower complications in high-risk wounds. There is a debate in the literature as to whether ciNPWT is effective at preventing complications in VHR-PAN. The aim of our study was to evaluate if ciNPWT improves outcomes of VHR-PAN.

Abdominal Body Contouring: Does Body Mass Index Affect Clinical and Patient Reported Outcomes?

BACKGROUND

Obese individuals are thought to be higher risk for complications after excisional abdominal body contouring (EAC) due to co-morbidities and significant tissue resection.

OBJECTIVES

We comparatively analyzed EAC patients with Body Mass Index (BMI) ≥35 kg/m² and BMI <35 kg/m² to highlight key differences in clinical and patient-reported-outcomes (PROs).

METHODS

Patients ≥18 years-old undergoing EAC by a single surgeon from 01/2018-01/2020 were identified and separated into cohorts based on BMI (<35 and ≥35 kg/m²). Patients were excluded if they had a cosmetic abdominoplasty without history of bariatric surgery or massive weight loss, or if they had <1000 gs of tissue resected. Clinical outcomes and PROs using the BODY-Q were comparatively analyzed.

RESULTS

70 total patients with median BMIs of 30[26-32] and 41[37-45] kg/m² in each cohort, were identified. Patients with BMI ≥35 kg/m² were more likely to have higher ASA (P<0.01) and use of incisional negative pressure wound devices (P = 0.042). Alternatively, they were less likely to have had concurrent liposuction (P = 0.05). There were no differences in development of an SSO, SSI or SSOpi (P>0.05) between cohorts. Multivariate logistic regression showed that BMI ≥35 kg/m², iNPWD and liposuction were not associated with the development of complications. PROs demonstrated improvement in multiple domains despite BMI.

CONCLUSION

There was no association with BMI ≥35 kg/m² and the development of complications within our cohort. We encourage preoperative weight loss when possible, however these procedures can be performed safely with acceptable outcomes even in individuals who are obese and/or require extensive tissue removal.

Utilization of a Novel Negative Pressure Platform Wound Dressing on Surgical Incisions: A Case Series

Background:

Closed incision negative pressure therapy (ciNPT) has been shown to improve wound healing for patients at high risk for wound complications. Current devices consist of opaque interface dressings that do not allow ongoing visual evaluation of the surgical incision and utilize a negative pressure of −80 mm Hg to −125 mm Hg. The Negative Pressure Platform Wound Dressing (NP-PWD) was developed to address these aspects. This case series is the first evaluation of the NP-PWD in a clinical setting.

Methods:

Patients aged 18–85 undergoing an operation with an anticipated incision and primary closure were screened. Demographics, comorbidities, and operation performed were recorded. Following closure, the incision was measured and photographed before NP-PWD placement. The NP-PWD was removed at the first postoperative check (POC) between postoperative days (PODs) 3–5. Subjects were followed until PODs 9–14. POCs consisted of incision assessment, measurement, photography, and adverse event monitoring.

Results:

A total of 8 patients with 10 incisions were included in the study. Five patients were men. Median age was 56 years (IQR 53–74 years). All incisions were intact and without inflammation or infection at all POCs. Three adverse events, including small blisters and interruption of therapy, were noted.

Conclusions:

This case series reports that patients tolerated the NP-PWD on closed surgical incisions well and that all incisions were intact without evidence of inflammation or infection after 2 weeks of follow-up. Future controlled, clinical studies should further examine the safety and efficacy of the use of the NP-PWD.