Background: The obesity epidemic and the surge in bariatric surgery have generated a new category of complex plastic surgery patients. In the plastic surgery community, correction of skin and soft tissue deformities after massive weight loss is an increasingly important branch of our surgical repertoire. While the postoperative course of bariatric surgery population has been investigated, these investigations do not extend into the period of body contouring and long-term adjustment. The current climate demands that we begin to record and assess the outcomes and characteristics of this rapidly expanding population. Methods: At the University of Pittsburgh, we have initiated prospective collection of pre, intra, and post-operative patient data that comprise our clinical research registry. Since November 2003, we have attained informed consent from 162 patients who present to the Life After Weight Loss clinic. Data was collected at the following time points: 1) At initial consultation; 2) Subsequent preoperative consultations; 3) Intra- and peri-operative period; 4) Postoperative visits (at 1 wk, and at 1, 3, and 6 months). Specialized data collection sheets were designed for all time points, and maintained as part of the medical record. Any postoperative complication was flagged in the patient records, and followed until complete resolution. Results: Complete pre-, intra- and postoperative data has been collected for 85 patients (63 females, 12 males). Mean age was 44 ± 10 years. All 85 underwent panniculectomy, abdominoplasty, or fleur-de-lis abdominoplasty. 45 had multiple procedures, and 19 underwent three or more procedures. The breakdown of the most common additional procedures were: 9 Ventral hernia repairs, 18 circumferential or posterior lower body lifts, 16 medial thighplasties, 12 brachioplasties, and 14 breast reductions/mastopexies/chest reshaping procedures. Average total operative time was 3.5 ± 2.4 hours. Two patients required intraoperative transfusions, one due to hypotension, and the other due to coagulopathy. We had seven cases of postoperative transfusions, due to various triggers including hypotension, low urine output, orthostasis, postoperative bleeding, and low hematocrit. In total, 8 out of 85 patients received transfusions. 6 of the 8 patients had multiple procedures. Postoperatively, we observed 23 incidences of wound dehiscence in 19 patients, with 3 requiring suture resuspension in the office setting. 15 patients had minor skin necrosis requiring topical antibiotics. 13 patients had at least one seroma, totaling 25 incidences of seroma. One patient required hospitalization for his seroma, and a second patient required excision in the operating room. 6 hematomas were observed and drained in the office setting. 6 wound infections were observed and treated, 4 with oral antibiotics, 1 with hospitalization and IV antibiotics, and 1 with incision and drainage in the operating room. 1 patient had bilateral lower extremity neuropathy after lower body lift, which resolved after 6 months. Conclusions: The Life After Weight Loss Research Registry is a proactive and efficient method of tracking patient characteristics and clinical outcomes. The maintenance of the registry requires the organization and mobilization of a motivated team that records every incidence in a standardized manner. Within a year of its launch, our research registry has successfully tracked 85 patients, and this number will likely double in the next few months.
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