Panniculectomy after bariatric surgical weight loss: Analysis of complications and modifiable risk factors

Derickson, Michael; Phillips, Cody; Barron, Morgan R.; Kuckelman, John; Martin, Matthew J.; DeBarros, Mia

doi:10.1016/j.amjsurg.2018.02.008

Cited by 26 publications

(25 citation statements)

References 34 publications

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“…Patients with increased mFI-5 were significantly more likely to have an ASA class >3, which has been identified as an independent risk factor for morbidity following panniculectomy. 31 , 32 In addition, patients with increased mFI-5 scores were more likely to be men, which has been previously identified as an independent risk factor for complications after abdominoplasty. 29 …”

Section: Discussionmentioning

confidence: 85%

“…Several studies have shown that higher preoperative BMI is an independent risk factor for the development of postoperative complications following panniculectomy. 32 – 34 The increased rate of postsurgical complications in obese patients is thought to arise from associated comorbidities, as well as physiologic changes, such as chronic low-level inflammation and impaired drug clearance. 35 , 36 Although the relationship between frailty and BMI is unclear, there is new literature exploring the contribution of BMI to frailty and their prognostic values for perioperative planning following bariatric surgery.…”

Section: Discussionmentioning

confidence: 99%

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Modified Frailty Index Predicts Postoperative Complications following Panniculectomy in the Elderly

Lee

Alfonso

Kantar

et al. 2020

Plastic and Reconstructive Surgery - Global Open

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Background: Due to the high complication rate of panniculectomies, preoperative risk stratification is imperative. This study aimed to assess the predictive value of the 5-item modified frailty index (mFI-5) for postoperative complications in the elderly following panniculectomy. Methods: A retrospective cohort study of the American College of Surgeons National Surgical Quality Improvement Program database for patients over the age of 65 years who underwent a panniculectomy between 2010 and 2015 was conducted. The mFI-5 score was calculated for each patient based on the presence of diabetes, hypertension, congestive heart failure, chronic obstructive pulmonary disease, and dependent functional status, and an mFI-5 score of 2 was used as a cutoff. Multivariate logistic and linear regression analysis was used to determine the validity of the mFI-5 as a predictor of postoperative complications. Results: A total of 575 patients were analyzed. Patients with an mFI-5 score of 2 or more (421; 73.2%) had significantly higher rates of wound complications (19.5% versus 12.8%; P = 0.03), overall complications (33.8% versus 19.5%; P < 0.001), and significantly longer hospital length of stay (3.6±5.0 versus 1.9±3.0; P < 0.001). mFI-5 score of 2 or more was an independent risk factor for wound complications (odds ratio, 1.26; 95% confidence interval, 1.08–2.20; P = 0.04) and overall complications (odds ratio, 1.34; 95% confidence interval, 1.09–2.15; P = 0.02). Conclusions: Frailty, as measured by the mFI-5, holds a predictive value regarding outcomes of wound complications and overall complications in elderly patients after panniculectomy. The mFI-5 score can be used to identify high-risk patients before surgery.

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Section: Discussionmentioning

confidence: 85%

Section: Discussionmentioning

confidence: 99%

Modified Frailty Index Predicts Postoperative Complications following Panniculectomy in the Elderly

Lee

Alfonso

Kantar

et al. 2020

Plastic and Reconstructive Surgery - Global Open

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“…According to the latest available global statistics from the International Society of Aesthetic Plastic Surgery, surgical procedures involving the body and extremities, such as abdominoplasty, buttock lift, and lower body lift, increased by 7% within just 1 year, reaching almost 3.5 million surgeries performed annually 17 . Despite its potentially positive effects and increasing prevalence, BCS is not a standard post‐bariatric treatment for excess skin folds and only a minority of patients undergo BCS 18,19 . In addition, there exists an ongoing debate on whether BCS contributes to more than cosmetic outcomes; moreover, there is inconclusive evidence to suggest that HRQoL improves after BCS 12 …”

Section: Introductionmentioning

confidence: 99%

A systematic review of body contouring surgery in post‐bariatric patients to determine its prevalence, effects on quality of life, desire, and barriers

et al. 2021

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Summary Many post‐bariatric patients have impaired health‐related quality of life (HRQoL) due to excess skin following weight loss; however, it is inconclusive whether body contouring surgery (BCS) improves this impairment. We aimed to comprehensively summarize existing evidence of the effect of BCS on the HRQoL (primary outcome) and determine the prevalence of, the desire for, and barriers to BCS (secondary outcomes). Randomized controlled trials, cohort, cross‐sectional, case–control, and longitudinal studies were systematically searched in PubMed, Embase, the Cochrane Central, and Web of Science. After screening 1923 potential records, 24 studies (representing 6867 participants) were deemed eligible. Only 18.5% of respondents from cross‐sectional studies underwent BCS, with abdominal BCS as the most common procedure. Most participants desired BCS but listed “cost” and “lacking reimbursement” as the main barriers. Results suggest that most post‐bariatric patients who underwent BCS experienced improvements in their HRQoL, which could be seen in almost every dimension evaluated, including body image and physical and psychosocial functions. Therefore, both bariatric and plastic surgeons should regard BCS not only as an aesthetic supplement but also as a vital part of functional recovery in the surgery‐mediated weight loss journey and, thus, provide it to more post‐bariatric patients.

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“…Panniculectomy following significant fluctuations in weight has been demonstrated to significantly improve quality of life through improved skin hygiene, decreased infectious issues, and improved psychosocial well-being. 1 , 2 Given the relatively high overall complication rates following panniculectomy, which has been cited to range between 21.2% and 56%, 5 , 7 , 27 , 28 the investigation of additional interventions to lower the complication profile of panniculectomy is necessary.…”

Section: Discussionmentioning

confidence: 99%

Defining the Role for Topically Administered Tranexamic Acid in Panniculectomy Surgery

Weissler¹,

Kuruoglu²,

Salinas³

et al. 2022

Aesthetic Surgery Journal Open Forum

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Background Abdominal panniculectomy after weight loss is a common procedure that despite associated high patient satisfaction continues to have a high post-operative complication profile. Several modifiable risk factors as well as surgical approaches, such as Scarpa’s fascia preservation, use of tissue adhesives, and progressive tension suture techniques. However, the use of tranexamic acid (TXA) has not been previously described in panniculectomy surgery. Objectives To improve the safety and predictability of this procedure, the authors aim to investigate the use of topically administered TXA during panniculectomy surgery to determine whether it reduces seroma, hematoma, and drain duration. Methods The authors retrospectively reviewed consecutive patients who underwent panniculectomy (January 2010 to January 2022). Pertinent perioperative details were collected. Outcome measures included: hematoma requiring surgical evacuation, clinically significant seroma requiring percutaneous aspiration, and drain duration. Patients with a history of thromboembolic diseases and those taking anticoagulation/antiplatelet medications were excluded. Patients who had received TXA were compared to a historical control group who had not received TXA. Results A total of 288 consecutive patients were included. Topical TXA was administered in 56 (19.4%) cases. The mean (standard deviation [SD]) follow-up was 43.9 (37.4) months [3.7 years]. The median (range) resection weight was 2.6 kg (0.15 – 19.96 kg). With regards to seroma and hematoma formation, the univariate logistic regression analysis demonstrated that the use of TXA did not reduce the likelihood of developing seroma or hematoma (odds ratio, OR= 1.7, 95% confidence interval, CI [0.56 – 4.8], p= 0.38 and OR= 2.1, 95% CI [0.4 – 11.8], p= 0.42), respectively. The mean (SD) duration of drains was slightly lower in the TXA group [18.1 (12.1) days vs 19.8 (13.9) days], however, this difference was not statistically significant, albeit clinically significant. TXA-related complications were not observed. Conclusions As the use of TXA in plastic surgical procedures continues to expand, the utility of TXA in panniculectomy and abdominoplasty has not been elucidated. Although prior studies support the use of tranexamic acid as a pharmacologic adjunct to help reduce hematoma and seroma, the use of TXA was not associated with a statistically significant reduction in seroma, hematoma, or drain duration following panniculectomy surgery. Prospective, randomized controlled studies on the use of TXA in panniculectomy or abdominoplasty are needed.

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Panniculectomy after bariatric surgical weight loss: Analysis of complications and modifiable risk factors

Cited by 26 publications

References 34 publications

Modified Frailty Index Predicts Postoperative Complications following Panniculectomy in the Elderly

Modified Frailty Index Predicts Postoperative Complications following Panniculectomy in the Elderly

A systematic review of body contouring surgery in post‐bariatric patients to determine its prevalence, effects on quality of life, desire, and barriers

Defining the Role for Topically Administered Tranexamic Acid in Panniculectomy Surgery

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