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Youssefzadeh AC, Klar M, Seifert GJ, Mandelbaum RS, Sangara RN, McCarthy LE, Cheng V, Matsushima K, Ouzounian JG, Matsuo K. Pregnancy characteristics and outcomes after bariatric surgery: national-level analysis in the United States. Surg Obes Relat Dis 2023; 19:364-373. [PMID: 36470811 DOI: 10.1016/j.soard.2022.10.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 09/16/2022] [Accepted: 10/16/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND Bariatric surgery is an effective surgical treatment for weight reduction in individuals with obesity. Pregnancy outcomes related to prior bariatric surgery are currently under active investigation. OBJECTIVE To assess national-level trends, characteristics, and outcomes of pregnancy after bariatric surgery in the United States. SETTING Retrospective cohort study queried the National Inpatient Sample. METHODS The study population was 14,648,135 patients who had vaginal or cesarean delivery from January 2016 to December 2019. Exposure allocation was based on the history of bariatric surgery. The main outcomes were (1) trends and characteristics related to bariatric surgery, assessed with multivariable binary logistic regression model; and (2) Centers for Disease Control and Prevention-defined severe maternal morbidity, assessed by propensity score matching and generalized estimating equation. RESULTS A total of 53,950 (.4%) patients had prior bariatric surgery. The number of patients with prior bariatric surgery increased from .3% to .5%, and this trend remained independent in multivariable analysis (P < .001). Patients who had bariatric surgery were also more likely to be older and have obesity, medical co-morbidities, fetal growth restriction, preterm birth, and cesarean delivery compared with those without bariatric surgery (all, P < .05). In a propensity score matched model, patients who had bariatric surgery were more likely to receive blood product transfusion (2.3% versus 1.6%; odds ratio = 1.45; 95% confidence interval, 1.19-1.77), but severe maternal morbidity other than blood product transfusion was comparable to those without (1.1% versus 1.4%; odds ratio = .80; 95% confidence interval, .63-1.02). CONCLUSION There is a gradual increase of pregnancy after bariatric surgery in recent years in the United States.
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Affiliation(s)
- Ariane C Youssefzadeh
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, California
| | - Maximilian Klar
- Department of Obstetrics and Gynecology, University Medical Center Freiburg, University of Freiburg, Freiburg, Germany
| | - Gabriel J Seifert
- Department of General and Visceral Surgery, University Medical Center Freiburg, University of Freiburg, Freiburg, Germany
| | - Rachel S Mandelbaum
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, California; Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, California
| | - Rauvynne N Sangara
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, California
| | - Lauren E McCarthy
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, California; Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Vincent Cheng
- Division of Acute Care Surgery, Department of Surgery, University of Southern California, Los Angeles, California
| | - Kazuhide Matsushima
- Division of Acute Care Surgery, Department of Surgery, University of Southern California, Los Angeles, California
| | - Joseph G Ouzounian
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, California
| | - Koji Matsuo
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, California; Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California.
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Ibrahiem SMS. Investigating the Safety of Multiple Body Contouring Procedures in Massive Weight Loss Patients. Aesthetic Plast Surg 2022; 46:2891-2902. [PMID: 35650300 PMCID: PMC9729125 DOI: 10.1007/s00266-022-02941-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 05/08/2022] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Deformities after massive weight loss are usually severe and affect many parts of the body, negatively impacting patients' social and intimate lives. A common request of patients after massive weight loss is to treat more than one anatomical area in one surgical procedure. Advantages include a single recovery period, lower surgical costs, and faster patient satisfaction. Disadvantages may include increased need for blood transfusions, longer hospital stay, and increased risk of common complications. OBJECTIVE The main objective of the study is to compare operative risk, hospital length of stay, complication rate, and patient satisfaction in MWLP according to the number of surgical procedures performed in the same surgical setting. PATIENTS AND METHODS This is a retrospective case-control study of 653 MWLP who underwent multiple contouring procedures simultaneously in a single surgical procedure. All patients underwent surgery between 2016 and 2020. The patients studied were divided into 4 groups according to the number of anatomical areas operated on. RESULTS A total of 1254 body contouring procedures were included in the study. Follow-up time ranged from 13 to 41 months, with a mean of 17 months. The mean age in the study was 33 years old. Women accounted for 78% of the studied population and men accounted for 22%. The overall complication rate (major and minor) was 105 cases (16.07%) in all groups CONCLUSION: Patient satisfaction was highest in patients who underwent 2-3 procedures within the same surgical setting compared to patients who underwent +3 procedures. Nevertheless, this is clinically insignificant. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Saad Mohamed Saad Ibrahiem
- grid.7155.60000 0001 2260 6941Department of Plastic Surgery, Reconstructive Surgery, and Burn Management, Faculty of Medicine, Alexandria University, Champollion Street, El-Khartoum Square, Azarita Medical Campus, Alexandria, 21111 Egypt
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Raghuram AC, Yu RP, Gould DJ. The Addition of Partial or Circumferential Liposuction to Abdominoplasty Is Not Associated With a Higher Risk of Skin Necrosis. Aesthet Surg J 2021; 41:NP433-NP444. [PMID: 32856688 DOI: 10.1093/asj/sjaa251] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Combining abdominoplasty with liposuction is a common practice for optimal patient aesthetic outcomes. In the past, several practitioners have argued against liposuction due to the potential for vascular insufficiency, especially with central liposuction. Despite these concerns for flap damage with resultant necrosis, the incidence of this complication has not been comprehensively investigated. OBJECTIVES The authors therefore examined the incidence of necrotic complications, including skin and fat necrosis as well as partial/total flap loss, in patients who underwent abdominoplasty alone (AA) or abdominoplasty with partial or circumferential liposuction (APCL). METHODS Literature searches were performed in PubMed/Medline and Embase with no query limits. For the systematic review, data from the studies were extracted into a form including primary author, publication year, study design, number of AA and APCL patients, abdominal zone(s) treated with liposuction, average lipoaspirate volume, follow-up time, necrotic complications, and revision procedures. A meta-analysis was separately performed for 13 studies that included patients who underwent both AA and APCL. RESULTS The overall rate of necrotic complications was lower in the APCL group (0.39%) compared with the AA group (1.01%). The incidence of necrotic complications was low for all patients, with a pooled partial flap loss rate of 0.24% and a pooled skin necrosis rate of 0.23%. The forest plots revealed that patients who underwent APCL do not face a higher risk of skin necrosis or revision compared with those who underwent AA. CONCLUSIONS Performing APCL is a safe combined procedural approach and can confer added benefits of improved patient satisfaction and aesthetic outcomes. LEVEL OF EVIDENCE: 4
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Affiliation(s)
- Anjali C Raghuram
- Division of Plastic and Reconstructive Surgery, Keck School of Medicine of USC, Los Angeles, CA
| | - Roy P Yu
- Division of Plastic and Reconstructive Surgery, Keck School of Medicine of USC, Los Angeles, CA
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Krauss S, Medesan R, Black J, Medved F, Schaefer R, Schaller HE, Daigeler A, Wahler T. Outcome of Body-Contouring Procedures After Massive Weight Loss. Obes Surg 2020; 29:1832-1840. [PMID: 30778847 DOI: 10.1007/s11695-019-03773-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND With the increased popularity of bariatric surgery, the demand for body-contouring procedures is growing. Associated with these procedures are a number of complications due to different risk factors and patients' characteristics. The aim of this study was to assess the outcome of body-contouring procedures and correlate it to possible risk factors. METHODS The study included a collective of 112 patients who underwent 157 body-contouring procedures. Patients' characteristics, risk factors, and complications have been recorded. Three groups were formed based on the type of surgical procedure to perform correlations of BMI, weight of resected tissue, and length of hospital stay using Spearman's rank test. Correlations between patients' risk factors and complication occurrence were analyzed with Fisher's exact test. RESULTS The most common procedure patients underwent was the classic abdominoplasty (n = 53). A significant correlation was found between preoperative BMI and weight of resected tissue in abdominoplasties (rho = 0.69), Fleur-de-Lis abdominoplasties (rho = 0.64), and body lifts (rho = 0.60). There was a significant correlation between weight of resected tissue and length of hospital stay (rho = 0.53) and preoperative BMI and length of hospital stay (rho = 0.4) as well. There was no significant correlation between patients' comorbidities or smoking status and the postoperative complication rate. The mean weight of resected tissue was higher in patients with than without complications requiring surgical revision. CONCLUSIONS The relevance of risk factors commonly believed to have an influence on postoperative complications should be revised. The weight of resected tissue has an influence on complication.
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Affiliation(s)
- Sabrina Krauss
- Department of Hand, Plastic and Reconstructive Surgery, BG Trauma Center, Eberhard-Karls University of Tübingen, Schnarrenbergstr. 95, 72076, Tübingen, Germany
| | - Raluca Medesan
- Department of Hand, Plastic and Reconstructive Surgery, BG Trauma Center, Eberhard-Karls University of Tübingen, Schnarrenbergstr. 95, 72076, Tübingen, Germany
| | - Jaantje Black
- Department of Hand, Plastic and Reconstructive Surgery, BG Trauma Center, Eberhard-Karls University of Tübingen, Schnarrenbergstr. 95, 72076, Tübingen, Germany
| | - Fabian Medved
- Department of Hand, Plastic and Reconstructive Surgery, BG Trauma Center, Eberhard-Karls University of Tübingen, Schnarrenbergstr. 95, 72076, Tübingen, Germany
| | - Ruth Schaefer
- Department of Hand, Plastic and Reconstructive Surgery, BG Trauma Center, Eberhard-Karls University of Tübingen, Schnarrenbergstr. 95, 72076, Tübingen, Germany
| | - Hans-Eberhard Schaller
- Department of Hand, Plastic and Reconstructive Surgery, BG Trauma Center, Eberhard-Karls University of Tübingen, Schnarrenbergstr. 95, 72076, Tübingen, Germany
| | - Adrien Daigeler
- Department of Hand, Plastic and Reconstructive Surgery, BG Trauma Center, Eberhard-Karls University of Tübingen, Schnarrenbergstr. 95, 72076, Tübingen, Germany
| | - Theodora Wahler
- Department of Hand, Plastic and Reconstructive Surgery, BG Trauma Center, Eberhard-Karls University of Tübingen, Schnarrenbergstr. 95, 72076, Tübingen, Germany.
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Louri NA, Ammar HM, Abdulkariml FA, Alkhaldi TASAE, AlHasan RN. Abdominoplasty: Pitfalls and Prospects. Obes Surg 2020; 30:1112-1117. [DOI: 10.1007/s11695-019-04367-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Romano L, Zoccali G, Orsini G, Giuliani M. Reducing complications in post-bariatric plastic surgery: our experience and literature review. ACTA BIO-MEDICA : ATENEI PARMENSIS 2019; 90:475-481. [PMID: 31910172 PMCID: PMC7233755 DOI: 10.23750/abm.v90i4.7405] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Accepted: 09/04/2019] [Indexed: 11/23/2022]
Abstract
Background: With the rise in obesity, there has been a similar increase in bariatric surgery. This resulted in numerous patients losing significant weight with accompanying circumferential body contouring issues. This has led to an amazing increase in the number of body contouring procedures performed. Methods: The aim of this work is to revise the cases of body contouring in 78 ex-obese patients who underwent body contouring surgery in the Department of Health Life and Environmental Sciences – Plastic Reconstructive and Aesthetic Plastic Surgery Section, from 2007 to 2016. Results: The authors have noticed a deep relationship between adverse events and cigarette smoking and with pre-operative BMI. Regardless of these variables, the authors focused on the protocol for the management of patients, which required a collaboration between medical and nursing staff. Conclusions: Ex-obese patients have an important risk for complications, but the comparison of our personal data with those of the international literature confirms the efficacy of our management protocol with regard to the prevention of complications. (www.actabiomedica.it)
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Roxo AC, Del Pino Roxo C, Marques RG, Rodrigues NCP, Carneiro DV, Souto FMDC, Nahas FX. Endocrine-Metabolic Response in Patients Undergoing Multiple Body Contouring Surgeries After Massive Weight Loss. Aesthet Surg J 2019; 39:756-764. [PMID: 30107469 DOI: 10.1093/asj/sjy195] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The endocrine-metabolic response to trauma is directly related to its magnitude, but little is known about the adverse effects of combined surgical procedures on morbidity. OBJECTIVES The authors sought to evaluate risk factors by measuring the endocrine-metabolic response in patients who underwent multiple body-contouring surgeries after massive weight loss. METHODS This prospective, randomized, interventional study included 46 massive weight loss patients who experienced a weight loss >30% of their body mass index (BMI) and were referred for body contouring surgery. Patients were randomly allocated to the control group (n = 10) or intervention group (n = 36), which in turn was divided into 3 subgroups (n = 12, each) according to BMI, surgical time, and scar length values. Blood samples were collected from all patients at different time points to assess biological stress markers. RESULTS Levels of IL-6 in patients in the higher ranges of BMI and operating time and with more extensive scar length were significantly higher in the immediate postoperative period compared with baseline. Concentrations of noradrenaline were significantly higher 24 hours after surgery compared with baseline only in patients in the higher range of operating time. A higher level of IL-6 at 72 hours after surgery compared with baseline was associated with more extensive scar length. Levels of other biological stress markers did not significantly differ. CONCLUSIONS The combination of surgical procedures did not significantly affect the concentrations of most biological stress markers. The variable of operating time most influenced increase in plasma concentrations of stress markers. LEVEL OF EVIDENCE: 1
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Affiliation(s)
- Ana Claudia Roxo
- Division of Plastic and Reconstructive Surgery, Pedro Ernesto University Hospital, Rio de Janeiro State University (UERJ), Rio de Janeiro, Brazil
| | - Carlos Del Pino Roxo
- Chief of Plastic and Reconstructive Surgery Department at Andarai Federal Hospital, Rio de Janeiro, Brazil
| | - Ruy Garcia Marques
- Graduate Program in Physiopathology and Surgical Sciences, Department of General Surgery, UERJ, Rio de Janeiro, Brazil
| | | | - Diego Vigna Carneiro
- Division of Plastic and Reconstructive Surgery, Federal Hospital at Andaraí, Rio de Janeiro, Brazil
| | | | - Fabio Xerfan Nahas
- Division of Plastic Surgery, Federal University of São Paulo, São Paulo, Brazil
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Complications after lower body contouring surgery due to massive weight loss unaffected by weight loss method. J Plast Reconstr Aesthet Surg 2018; 72:649-655. [PMID: 30616907 DOI: 10.1016/j.bjps.2018.12.030] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 10/28/2018] [Accepted: 12/02/2018] [Indexed: 01/08/2023]
Abstract
Body contouring surgery following massive weight loss positively affects a patient's quality of life. However, the procedure is prone to complications. Herein, we stratified complications timewise. Furthermore, we examined whether the weight loss method - bariatric surgery or lifestyle changes - affected the frequency or severity of complications. In this single-centre retrospective analysis, we included 158 patients with massive weight loss undergoing body contouring surgery between 2009 and 2015. We recorded 96 complications in 80 patients, with an overall rate of 51%. Most complications (80.2%) were minor (Clavien-Dindo grades 1 and 2) and superficial wound infections. Immediate complications (0-24 hours post-operation) affected 8.3% of patients, with early complications (1-7 post-operative days) affecting 16.7% of them and late complications (8-30 post-operative days) affecting 58.3% of them. We found no statistical difference in complication rates when comparing bariatric and non-bariatric patients. Older age (p = 0.042) at operation is associated with an increased risk for immediate haematoma or bleeding requiring surgery. Among early complications, a high maximum weight (p = 0.035) and a high preoperative weight (p = 0.0053) significantly correlated with a haematoma or bleeding requiring surgery. For late complications, seroma correlated with older age (p = 0.0061). Complications are primarily minor and non-life threatening after body contouring surgery because of frequent massive weight loss. Here, no particular subgroup of massive weight loss patients appeared more prone to complications. Thus, for each patient, the risks associated with body contouring surgery following massive weight loss should be considered individually.
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