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Abdominoplasty complications

Abdominoplasty: Risk from combined procedures

Credit: Paravis
Combined procedures can significantly increase complication rates and should be considered carefully in higher-risk patients

Abdominoplasty has a higher risk of major complications than other cosmetic plastic surgery procedures, according to a study ‘Abdominoplasty: Risk Factors, Complication Rates, and Safety of Combined Procedures’, in the journal Plastic and Reconstructive Surgery (the official medical journal of the American Society of Plastic Surgeons, ASPS). The paper found that complication risk is particularly high for the large proportion of patients undergoing abdominoplasty in combination with other procedures and the authors of the paper state: “Combined procedures can significantly increase complication rates and should be considered carefully in higher-risk patients.”

The study led by Dr Julian Winocour of Vanderbilt University, Nashville, and colleagues assessed abdominoplasty complication rates and risk factors using the nationwide CosmetAssure database. CosmetAssure is an insurance programme providing coverage for complications related to cosmetic plastic surgery procedures, which are typically not covered by health insurance.

Abdominoplasty is the sixth most common cosmetic surgical procedure performed in the United States, with more than 117,000 procedures performed in 2014, according to ASPS statistics. The number of abdominoplasties has increased in recent years, partly because of the increased number of patients undergoing body contouring surgery to remove excess skin and tissue after massive weight loss.

The study included more than 25,000 abdominoplasties performed between 2008 and 2013, representing about 14 percent of all procedures in the database. The researchers performed an univariate and multivariate analysis evaluating risk factors, including age, smoking, body mass index, sex, diabetes, type of surgical facility, and combined procedures.

The authors identified 25,478 abdominoplasties from 183,914 procedures in the database. Of these, 8,975 patients had abdominoplasty alone and 16,503 underwent additional procedures. Ninety-seven percent of abdominoplasty patients were women; the average age was 42 years. The number of complications recorded was 1,012 (4.0 percent overall rate versus 1.4 percent in other aesthetic surgery procedures). Of these, 31.5 percent were hematomas, 27.2 percent were infections and 20.2 percent were suspected or confirmed venous thromboembolism.

On multivariate analysis, significant risk factors (p<0.05) included male sex (relative risk, 1.8), age 55 years or older (1.4), body mass index greater than or equal to 30 (1.3), multiple procedures (1.5), and procedure performance in a hospital or surgical center versus office-based surgical suite (1.6). Combined procedures increased the risk of complication (abdominoplasty alone, 3.1 percent; with liposuction, 3.8 percent; breast procedure, 4.3 percent; liposuction and breast procedure, 4.6 percent; body-contouring procedure, 6.8 percent; liposuction and body-contouring procedure, 10.4 percent).

Combined procedures were a key risk factor for complications - compared to the 3.1 percent rate with abdominoplasty alone, risk increased when abdominoplasty was combined with other procedures: up to 10.4 percent when abdominoplasty was combined with body contouring plus liposuction. After adjustment for other factors, the relative risk of major complications was 50 percent higher with combined procedures.

Other risk factors for major complications included male sex, age 55 years or older, and obesity. Risk was lower when abdominoplasty was performed in an office-based surgical suite, compared to a hospital or surgical centre.

Julian Winocour

"Surgeons often refer patients with major illnesses, such as heart disease, to hospitals, which may be responsible for this observed trend in complications," said Winocour.

Diabetes and smoking - two major surgical risk factors - were not associated with a significant increase in complications after abdominoplasty.

"That likely reflected Board-certified plastic surgeons' practice of not offering abdominoplasty to poorly controlled diabetics and recommending strict smoking cessation for at least four weeks before and after surgery," added Wincour.

The study adds to previous evidence that abdominoplasty carries a higher complication rate than other cosmetic plastic surgery procedures.

"Although the overall incidence of major complications is low, such complications can leave a potentially devastating cosmetic outcome and pose a significant financial burden on the patient and surgeon," the researchers write.

The researchers draw special attention to the risk associated with multiple procedures, especially since nearly two-thirds of patients in the database underwent other cosmetic procedures combined with abdominoplasty. Winocour and colleagues suggest that some patients at high risk of complications might be better off undergoing staged rather than combination procedures.

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