Abdominal Contouring and Male Gender

Abstract

Background Males represent a significant portion of patients undergoing abdominal contouring. Despite this, there are few studies examining the implication of gender on complications. Objective The aim of this study was to examine the association between gender and early postoperative outcomes in patients undergoing abdominal contouring procedures. Methods The American College of Surgeons National Surgical Quality Improvement Program database (2006–2016) was queried to identify subjects undergoing panniculectomy or abdominoplasty. Minor and major complications were identified. Operative time and length of hospital stay were evaluated. A logistic regression model was used to examine associations between patient gender and adverse outcomes. Results Ten thousand four hundred seventy-three patients were identified. Of these, 4369 underwent abdominoplasties, and 6104 underwent panniculectomies. Males represented a higher percentage of the panniculectomy cohort (15.3% vs 9.2%). Males were older and generally had more comorbidities including diabetes, hypertension, chronic obstructive pulmonary disease, and elevated body mass index. Males also had a higher American Society of Anesthesiologists classification (P < 0.001). In the abdominoplasty cohort, male gender is an independent risk factor for any complication (odds ratio [OR], 1.3; confidence interval [CI], 1.16–1.45; P < 0.001) and major complications (OR, 1.52; CI, 1.01–2.29; P = 0.043). In the panniculectomy cohort, male gender is also an independent risk factor for any complication (OR, 1.47; CI, 1.24–1.75; P < 0.001) and major complications (OR, 1.43; CI, 1.12–1.83; P < 0.001). Males also had a significantly longer operative times in this cohort (171.3 vs 157.5 minutes; P < 0.001). Conclusions Male gender is independently associated with minor and major complications in these patient populations. With this knowledge, plastic surgeons may be better able to identify higher-risk individuals and educate patients on their risk profile.

Body Contour in the Post-Bariatric Male Patient

“…Male gender has been associated with increased risk of total complications and major complications following abdominoplasty or panniculectomy. 11 Complications are expected in this population, up to 25% of patients who undergo a single procedure present a complication, if procedures are added the risk increases up to 50%. The 2 most common complications are wound dehiscence (10% for single procedures and 30% for multiple procedures) and seroma (4% for single procedures and 19% for multiple procedures).…”

“Frailty Indices Outperform Historic Risk Proxies as Predictors of Post-Abdominoplasty Complications: An Analysis of a National Database”

“…Age, gender, and smoking status all have some association with complications after abdominoplasty. Database reviews 6 and retrospective studies 8 show age to be a significant independent risk factor for abdominoplasty complications, 5,14 which also increases risk further in obese patients. 3 This holds true even after adjusting for the increased comorbidities associated with advanced age.…”

“…These studies link increasing BMI to higher 30-day complication rates (minor and major), unplanned returns to the operating room, seroma, dehiscence, wound infections, and sepsis. 1,9,24 Each additional point of BMI increases patient risk, 5,11 with notable increases in complications at a BMI of 30 kg/m 2,6,14 and a 4.1-fold increase again at a BMI of 40 kg/m 2 . 5,9,10 Increasing resection weight, although associated with other comorbidities that increase surgical risk, is also significantly associated with increased risk, both as a continuous variable 14 and at certain cutoff values.…”

“…3 This holds true even after adjusting for the increased comorbidities associated with advanced age. 7 Male gender is also associated with an increased risk, 6 but some studies fail to show statistical significance; it is possible that the gender association with certain comorbidities serves as a confounder, or that the effect size is so small that the number of patients needed to assess it is prohibitively large. 24 The impact of smoking is difficult to assess; some studies show smoking to be an independent risk factor, 12 some studies do not, 5 and many of these studies do not capture rates of dehiscence or abdominoplasty flap necrosis, key complications thought to be associated with smoking.…”

“…4,5 Numerous studies report conflicting data regarding risk factors for abdominoplasty complications. Age, 3,[5][6][7][8] body mass index (BMI), 1,5,6,[9][10][11] and history of diabetes 1,5,7 are strongly supported as risk factors even after accommodating for their relationship to other comorbidities, although there is disagreement regarding specific complications and cutoffs. Smoking status 5,12,13 and history of bariatric surgery 1,3,4,12,14 are more variable, but have some support as risk factors.…”