Complications in Body Contouring: An Analysis of 1,797 Patients From the NSQIP Database

 Purpose

                  This study characterizes the overall incidence and risk factors associated with wound complications, major morbidity, and medical complications using a large, prospective dataset.

Methods

                  We retrospectively reviewed the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database (http://www.acsnsqip.org/) from 2005 to 2010 for all body contouring cases, including CPT codes brachioplasty, medial thigh lift, abdominoplasty, and suction assisted lipectomy (SAL).   Outcomes assessed included wound complications, major morbidities, and medical complications. 

Results

                  Seventeen hundred ninety seven patients underwent body contouring during the study period, the vast majority were female (n=1600, 89.0%). Average BMI of patients undergoing body contouring was 31.6, with a total of 239 morbidly obese individuals (BMI ³ 40kg/m2). The most common area of intervention was the trunk region, with 1,652 (91.9%) patients receiving abdominal contouring and/or contouring of the hips and buttocks. Breast contouring was performed in 254 (14.1%) patients, and contouring of the extremities in only 35 (2.0%). A total of 179 (10.0%) patients underwent suction-assisted-lipectomy as part of the contouring regiment.

                  While the majority of patients underwent only one contouring procedure (n=1,478, 82.3%), 271 (15.1%) underwent 2 procedures, and 43 (2.4%) underwent 3. Wound complications occurred in 114 (6.3%) individuals, while 122 (6.8%) patients suffered from a major morbidity, and 40 (2.2%) experienced a medical complication. Multivariate logistic regression revealed, the presence of multiple comorbidities (p=0.014, OR 15.87), presence of a bleeding disorder (p=0.026, OR 20.31), preoperative albumin level (p=0.003, OR 0.14), and malnutrition (p=0.065, OR 0.19), were associated with an increased odds of wound complication. Functional status (p=0.011, OR 9.71) was associated with an increased odds of major surgical morbidity. Lastly, BMI (p=0.03, OR 1.06), the presence of a bleeding disorder (p=0.017, OR 17.16), and preoperative albumin levels (p=0.043, OR 0.20), were associated with increased odds of medical complications.  

Conclusion

                  To the best of our knowledge this study represents the largest body contouring outcome study to date. We show several patient-related factors that were shown to influence the risk of complication, including preoperative albumin, BMI, bleeding disorder, and functional status. These findings highlight the critical importance of careful preoperative patient evaluation, including laboratory screening, and underscores the need for detailed patient counseling and risk stratification.