Body Contouring in Plastic Surgery: A Risk Assessment Model of Liposuction Volume as a Function of Body Mass Index
Ian Chow, BA1, Nima Khavanin, BS1, Philip J. Hanwright, BA1, Karol A. Gutowski, MD2, Keith M. Hume, MA3, Robert X. Murphy, Jr., MD, MS4, Mohammed S. Alghoul, MD1, John YS Kim, MD1.
1Northwestern University, Chicago, IL, USA, 2Ohio State University, Columbus, OH, USA, 3American Society of Plastic Surgeons, Chicago, IL, USA, 4Lehigh Valley Health Network, Allentown, PA, USA.
Significant controversy surrounds the maximum permissible lipoaspirate volume. No data exists to support a specific volume at which liposuction becomes unsafe; surgeons must instead rely on gestalt estimates of safe lipoaspirate volumes. This study represents the first attempt at quantifying the comprehensive risk associated with varying liposuction volumes and its interaction with body mass index (BMI).
Suction assisted lipectomies were identified from the Tracking Operations and Outcomes for Plastic Surgeons database. Multivariate regression models incorporating the interaction between liposuction volume and BMI were used to assess the influence of liposuction volume on complications. A tool was developed that returns a single adjusted odds ratio for any combination of BMI and liposuction volume.
Of the 11,615 liposuction patients meeting inclusion criteria, 572 (4.9%) experienced a post-operative complication. Liposuction volume and BMI were significant independent risk factors for complications; however, increasing BMI exerts a protective effect on the risk associated with increases in lipoaspirate volume. When compared to a morbidly obese patient, the conversion of low volume liposuction to large volume liposuction results in a greater magnitude of increased risk in a patient with a lower BMI.
By quantifying the differential effect of BMI on liposuction volume, this analysis facilitates more accurate estimates of individualized risk by obviating the need to resort to absolute safety cutoffs or subjective impressions of risk.
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