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Liposuction safety

Safety of liposuction dependent on patient’s BMI

Credit: Victovoi
This study represents the first attempt to quantify the comprehensive risk associated with varying liposuction volumes and its interaction with BMI

The safe amount of fat to remove in patients undergoing liposuction depends on the patient's body mass index (BMI), according to a report, ‘Is There a Safe Lipoaspirate Volume? A Risk Assessment Model of Liposuction Volume as a Function of Body Mass Index’,in the issue of Plastic and Reconstructive Surgery, the official medical journal of the American Society of Plastic Surgeons (ASPS). There is currently no concrete data exist to support a specific volume at which liposuction becomes unsafe; surgeons rely on their own estimates, professional organisation advisories, or institutional or government-imposed restrictions. This study represents the first attempt to quantify the comprehensive risk associated with varying liposuction volumes and its interaction with BMI.

John YS Kim

"Our study shows that liposuction is associated with a very low complication rate, with major complications occurring in less than 1 in 1,000 patients," comments ASPS Member Surgeon John YS Kim of Northwestern University, Feinberg School of Medicine, Chicago. "It also calls into question the concept of simple absolute thresholds for lipoaspirate volume - the amount of liposuction that can be performed safely seems to depend in part on how much fat content a person begins with."

There's a long history of debate over the safe volume of fat tissue that can be removed by liposuction. Current ASPS guidelines define 5,000ml (five litres) as "large-volume liposuction" potentially associated with a higher risk of complications. But the guidelines acknowledge there is no scientific data to support an absolute cutoff point.

Kim and colleagues analysed data on more than 4,500 liposuction patients, drawn from the ASPS's "Tracking Operations and Outcomes for Plastic Surgeons" (TOPS) database. They evaluated the relationship between liposuction volume and complication risk, including interactions with the patient's BMI.

Overall, 4,534 patients who underwent liposuction were included in the analysis, with a total of 69 patients (1.5 percent) experiencing at least one postoperative complication. These patients underwent liposuction with an average volume of 2.1±1.8 litres and had an average BMI of 26.5±4.5 kg/m2. Patients who experienced one or more complications underwent procedures with higher average liposuction volumes (3.4±2.7 litres versus 2.1±2.7 litres; p<0.001) and had BMIs (28.2±4.3 kg/m2 versus 26.5±4.5 kg/m2; p=0.003) than patients who did not experience a complication.

The rate of medical (p=0.999) and hospital return (p=0.999) complications did not differ significantly between the large-volume and non–large-volume liposuction groups. Patients undergoing large-volume liposuction did, however, experience more overall (3.7 percent versus 1.4 percent; p=0.001) and surgical complications (3.7 percent versus 1.1 percent; p<0.001), attributable almost entirely to the higher rate of seroma (3.1 percent versus 0.8 percent; p<0.001).

Although both increasing liposuction volumes (OR, 1.37; 95 percent CI, 1.14 to 1.65; p<0.001) and body mass index (OR, 1.11; 95 percent CI, 1.01 to 1.23; p=0.039) independently increased the risk for complications, their combined interaction demonstrated a decrease in overall complications when each 250ml increase in lipoaspirate volume was accompanied by a simultaneous unit increase in body mass index (OR, 0.99; 95 percent CI, 0.98 to 0.99; p=0.007).

Recursive partitioning identified a liposuction volume per body mass index unit in excess of 103.8 ml per unit of body mass index (in kilograms per meter squared) as the threshold where overall complications increased significantly (2.9 percent versus 0.9 percent; p<0.001). This threshold was a significant independent predictor of overall complications (OR, 4.65; 95 percent CI, 2.66 to 8.14; p<0.001). To obtain a more clinically useful threshold for liposuction volumes, a threshold of 100 ml per unit of body mass index was evaluated and shown to be a predictor for overall complications, surgical complications, seroma, and operative infection.

“Although our findings can be readily applied to patients across a broad range of body mass indexes and lipoaspirate volumes, they are by no means comprehensive,” the authors note. “The likelihood of a complication may not be adequately captured at extremes of either value. Our model also does not account for extenuating factors that may be more relevant to a specific patient’s individualized risk for a complication.”

“Liposuction performed by board-certified plastic surgeons is safe, with an exceedingly low risk of life-threatening complications,” they concluded. “Traditional liposuction volume thresholds do not accurately convey individualized risk. By incorporating body mass index, we demonstrate that liposuction volumes in excess of 100 ml per unit of body mass index confer an increased risk of complications.”

Kim and colleagues introduced the concept of a "relative liposuction volume threshold" based on BMI. Kim and co-researcher Dr Karol Gutowski emphasised that this provides a relative threshold where complications start to increase, but does not imply an absolute limit on liposuction volumes. Other considerations such as length of surgery, adjunct procedures, and the patient's overall health status are also important to consider when evaluating liposuction risk.

"Our risk assessment tool can further aid shared decision-making between the surgeon and patient by linking BMI and liposuction volumes," added Kim.

Gutowski, who is also a member for the ASPS Patient Safety Committee and past Chairman of the ASPS Quality & Performance Metrics Committee, points out that these finding are only possible due to the surgery data contributed by Board-certified plastic surgeons. "By developing the TOPS database, ASPS is leading the way in safe and effective plastic surgery which benefits both patients and plastic surgeons," he said.

To access this paper, please click here

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