Johns Hopkins Hospital, Baltimore, MD, USA.
PURPOSE: The health benefits of massive weight loss achieved through either surgery or diet and exercise cannot be disputed. The sequela of massive weight loss includes functional and aesthetic deformity with laxity and redundancy of the skin as well as volume loss. This can be corrected with body contouring surgery. While published reports about technical management of these patients are beginning to appear, risk factors for complications following body contouring operations performed in obese patients status post significant weight loss are not known.
METHODS: Retrospective analysis of operative and clinic records of massive weight loss patients who had body contouring operations between March 1998 and October 2004 was performed. Patient factors included age, gender, medical comorbidities (hypertension, cardiac disease, diabetes, hypothyroidism, asthma, obstructive sleep apnea, osteoarthritis, Ehlers-Danlos Syndrome, GERD, history of DVT or PE), depression, tobacco use, and BMI at the time of body contouring operation. Outcome measures examined included seroma complication, wound dehiscence, blood transfusion of any amount, extended lengths of stay (greater than 2 days), and development of hernia.
RESULTS: A total of 139 patients were analyzed, with 82.7% female and a mean age of 41, on average 22.2 months status post bariatric operations. The mean pre-bariatric BMI was 56.7; the mean BMI at contour operation was 33.8. On multiple logistic regression, male gender was associated with significant risks for wound dehiscence (OR 6.4, p=0.01); there were also trends toward increased risks for wound dehiscence for patients with hypothyroidism (OR 4.3, p=0.06) or Ehlers-Danlos Syndrome (OR 18.7, p=0.05). In terms of risks of blood transfusion, asthma was the only variable that emerged with significant association (OR 13.7, p<0.01). For other outcome measures examined (seroma complication, extended lengths of stay, or elevated risk of hernia development), none of the patient factors examined was associated with significantly elevated patient risks.
CONCLUSIONS: Male gender, hypothyroidism, and Ehlers-Danlos Syndrome may be risk factors of wound dehiscence following body contour operations. Asthma may be a marker of poor general health status, and asthmatic patients are at increased risk for requiring blood transfusions. Noteably, age, hypertension, cardiac diseases, diabetes, sleep apnea, osteoarthritis, GERD, history of DVT or PE, depression, tobacco use, and BMI at body contour are not associated with any increased risk of complication in this analysis.