Contemporary Analysis of Rhytidectomy Using TOPS Database with 13,346 Patients
Mustafa Chopan, M.D., Sonja Samant, B.S., Bruce A. Mast, M.D., FACS.
University of Florida, Gainesville, FL, USA.
Purpose: Rhytidectomy is a popular procedure for facial rejuvenation, but a comprehensive and up-to-date appraisal is lacking. This study reports current practices, safety profile and complications following rhytidectomy in a large, prospective, multi-center database.
Methods: A prospective cohort of patients undergoing rhytidectomy between 2008 and 2016 was identified from the TOPS database. Perioperative data and patient characteristics were extracted and analyzed with respect to adverse events. Multivariate logistic regression evaluated for risk factors including age, gender, BMI, smoking, diabetes, duration, multiple procedures, type of surgical facility, anesthesia type and provider.
Results: 13,346 patients with a mean age of 60 years underwent rhytidectomies and a total of 31,206 CPT procedures. Most were healthy females with an ASA class < 3 (97%). On average 2.3 CPT procedures were performed in 3.8 hours per patient, and blepharoplasty was the most common adjunctive procedure. 50% of operations were performed in office-based settings, with mostly general anesthesia (63%) and under the supervision of an anesthesiologist (59%). The incidence of adverse events was 5.1%, and hematoma (1.9%), infection (0.89%) were the most frequent surgical complications. Male gender (OR 1.6), obesity (OR 1.7), smoking status (OR 1.6), procedure duration (OR 1.1), combined procedures (OR 1.3), general anesthesia (OR 1.7) and office-based facilities (OR 1.3) were associated with an increased odd of adverse events.
Conclusion: This is the largest analysis of rhytidectomy in a representative population. Rhytidectomy is a very safe procedure when performed by board-certified plastic surgeons. The study provides a standard reference for professionals when counseling patients and in guiding clinical practices.
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