Rates and Predictors of Readmission Following Body Contouring Procedures: An Analysis of 5100 Patients From The National Surgical Quality Improvement Program Database

Postoperative Outcomes in Body Contouring Procedures Following Glucagon-Like Peptide-1 Receptor Agonist Use: A 10-Year Analysis

BACKGROUND

Utilization of glucagon-like peptide-1 receptor agonists (GLP-1ras) has increased dramatically in recent years. Although GLP-1ras appear safe to use overall, it remains unclear whether preoperative GLP-1ra use impacts body contouring surgery outcomes.

OBJECTIVES

This study evaluates the postoperative course of patients receiving body contouring procedures by GLP-1ra use.

METHODS

This retrospective cohort study examined patients who received panniculectomies, brachioplasties, thighplasties, and abdominoplasties at a large academic institution between November 2014 and November 2024. Propensity score-matched analysis paired cohorts by age, smoking status, and BMI and hemoglobin A1c at the time of surgery. Univariate analyses and multivariable logistic regression were performed.

RESULTS

In total, 590 patients were included in this study. Of these, 100 patients utilized GLP-1ras before surgery. Propensity score-matched analysis paired 72 GLP-1ra and 143 non-GLP-1ra patients. Thirty day readmissions and emergency department visits in matched and unmatched cohorts were similar by GLP-1ra use (P > .05). Postoperative cellulitis occurred less frequently among GLP-1ra users in matched cohorts (P = .008); however, GLP-1ra use status did not predict cellulitis on multivariable logistic regression. Duration of GLP-1ra use and timing of discontinuation before surgery did not predict the incidence of wound dehiscence, seromas, or hematomas. Patients using GLP-1ras for obesity had lower rates of wound dehiscence than patients using GLP-1ras for diabetes (P = .028).

CONCLUSIONS

Compared with non-GLP-1ra controls, GLP-1ra users have similar postoperative outcomes following body contouring surgery. Wound dehiscence is more prevalent among patients taking GLP-1ras for diabetes compared with weight loss, potentially because of worse glycemic control or associated comorbidities.

LEVEL OF EVIDENCE: 3 (THERAPEUTIC)

Analysis of laboratory markers in body contouring procedures after bariatric surgery does not indicate particular risks for perioperative complications

BACKGROUND

Body contouring surgery after massive weight loss is associated with different risk factors. Wound healing disorders and seromas commonly occur postoperatively. Bariatric interventions lead to massive weight loss with excess skin and soft tissue. In this study, perioperatively collected laboratory markers of this special patient population were analyzed.

METHODS

Fifty-nine patients were analyzed retrospectively regarding bariatric surgery, weight loss, body contouring surgery, laboratory markers, and complication rates.

RESULTS

Body contouring surgery (n = 117) was performed in 59 patients. Weight loss was achieved after gastric bypass (40.1%), gastric banding (33.9%), or sleeve gastrectomy (26.0%), with an average of 69.2 kg. The most common body contouring procedure included abdominoplasty (n = 50), followed by thigh lift (n = 29), mammaplasty (n = 19), brachioplasty (n = 14), and upper body lift (n = 5). Analysis of laboratory markers revealed no exceptional and clinically relevant variations. Correlation analysis revealed associations between resection weight, amount of drain fluid, and particular laboratory markers.

CONCLUSION

Analysis of perioperative laboratory markers in this special patient population after massive weight loss did not indicate clinically relevant risk factors regardless of the type of bariatric or body contouring surgery. Body contouring surgeries after bariatric interventions prove to be safe and low risk concerning perioperative laboratory markers and postoperative hospitalization.

Tracking Complications and Unplanned Healthcare Utilization in Aesthetic Surgery: An Analysis of 214,504 Patients Using the TOPS Database

BACKGROUND

Tracking surgical complications and unplanned healthcare utilization is essential to inform quality initiatives in aesthetic surgery. This study used the Tracking Operations and Outcomes for Plastic Surgeons database to characterize rates and predictors of surgical complications and unplanned healthcare utilization across common aesthetic surgery procedures.

METHODS

The Tracking Operations and Outcomes for Plastic Surgeons database was queried for all patients undergoing breast augmentation, liposuction, blepharoplasty, rhinoplasty, and abdominoplasty from 2008 to 2019. Incidence and risk factors for complications and unplanned readmission, reoperation, and emergency room visits were determined.

RESULTS

A total of 214,504 patients were identified. Overall, 94,618 breast augmentations, 56,756 liposuction procedures, 29,797 blepharoplasties, 24,946 abdominoplasties, and 8387 rhinoplasties were included. A low incidence of perioperative complications was found, including seroma (1.1%), hematoma (0.7%), superficial wound complication (0.9%), deep surgical-site infection (0.2%), need for blood transfusion (0.05%), and deep venous thrombosis/pulmonary embolism (0.1%). Incidence of unplanned readmission, emergency room visits, and reoperation were 0.34%, 0.25%, and 0.80%, respectively. Patients who underwent an abdominoplasty more commonly presented to the emergency room and had unplanned readmissions or reoperations compared with other studied procedures. Furthermore, increased age, diabetes, higher body mass index, American Society of Anesthesiologists class, longer operative times, and pursuit of combined aesthetic procedures were associated with increased risk for unplanned health care use.

CONCLUSIONS

There is a low incidence of perioperative complications and unplanned healthcare utilization following common aesthetic surgery procedures. Continued entry into large national databases in aesthetic surgery is essential for internal benchmarking and quality improvement.

CLINICAL QUESTION/LEVEL OF EVIDENCE

Risk, III.

BMI and Revision Surgery for Abdominoplasties: Complication Definitions Revisited Using the Clavien-Dindo Classification

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.