Contemporary Analysis of Rhytidectomy Using TOPS Outcomes Registry 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: The objective of this study is to provide a contemporary evaluation of modern-day practices, safety profile and outcomes for rhytidectomy that would be broadly representative of US plastic surgeons.
Methods: ASPS outcomes registry, TOPS, was queried for patients undergoing rhytidectomy between 2008 and 2016. Perioperative data and patient characteristics were 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 rhytidectomy. Most were healthy females with an ASA class 1 or 2 (70%). 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. 63% had general anesthesia. An anesthesiologist was present for 59% of patients. The incidence of adverse events was 5.1%; hematoma (1.9%), seroma (0.62%) and infection (0.36%) were the most frequent surgical complications. Odds ratios for obesity (2.2), smoking (2.2), procedure duration (1.13) and office-based facilities (2.15) indicated increased risk for complications.
Conclusion: Rhytidectomy done by ASPS plastic surgeons is exceedingly safe. General anesthesia and anesthesiologists are most often employed. Surgery was done for 50% of patients in an office setting, but this was associated with an increased risk for complications. Modern practice guidelines can be derived from these data.
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