Panniculectomy Outcomes by Body Mass Index: an Analysis of 12,732 Cases

Abstract

Purpose With an increasing rate of obesity in the USA, bariatric surgery has become widespread, resulting in a greater number of patients seeking panniculectomy. The authors aim to determine the complication profile of panniculectomies by body mass index (BMI). Methods The 2012–2018 National Surgical Quality Improvement Program database was queried for all panniculectomy cases. Patients were assigned to a category by their calculated BMI. Rates of complications were compared across BMI ranges. Demographics, comorbidities, and perioperative factors were compared between those with and without complications. Multivariable analyses were performed to analyze the associations between BMI ranges and post-surgical complications. Results Twelve thousand seven hundred thirty-two cases were analyzed, of which 1759 (13.8%) had at least one postoperative complication. As BMI increased, patients were more likely to experience postoperative complications ( p <0.001). Patients experiencing complications were more likely to be male, older, of a higher BMI group, have a higher American Society of Anesthesiologists Personal Status classification, be an inpatient, have various comorbidities, or be undergoing a concurrent procedure. On multivariable analysis, patients who were overweight (OR=1.24, p =0.039), with class 1 (OR=1.72, p <0.001), class 2 (OR=2.10, p <0.001), or class 3 (OR=3.01, p <0.001) obesity were more likely to have a postoperative complication. Wound complications were particularly prevalent in patients who were overweight (OR=1.77, p =0.001) or with class 1 (OR=2.59, p <0.001), class 2 (OR=4.05, p <0.001), or class 3 ( p =5.84, p <0.001) obesity compared to non-overweight patients. Conclusion A higher BMI is associated with more postoperative complications, particularly wound healing complications, following panniculectomy in a dose-dependent manner. Graphical abstract Supplementary Information The online version contains supplementary material available at 10.1007/s11695-021-05468-w.

Surgical Delay of Thoracodorsal Artery Perforator Flaps for Total Autologous Breast Reconstruction

“…Although the superficial inferior epigastric artery (SIEA) perforator flap has been proposed as an alternative flap when DIEP perforator anatomy is not ideal for flap creation, the SIEA flap perforator anatomy is also unreliable in the setting of previous abdominal surgery 10 . With rising rates of obesity along with the increasing popularity of functional and cosmetic abdominal surgeries, 3,11,12 there is a need for reliable, non–abdominally based flaps for total autologous breast reconstruction. Although an obese body mass index (BMI) alone is not a contraindication to DIEP flap use in breast reconstruction, 13 there is an increased risk for donor site complications such as abdominal wall infection, hernia, or bulging 14–16 …”