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PURPOSE: With the increase in the number of bariatric surgical procedures, there has been a substantial increase in the number of patients presenting for body contouring surgery. Pre-operative assessment of nutrition and the use of laboratory data in this population has been emphasized; however, the utility of such measures remains to be determined. We investigated whether pre-operative nutritional and laboratory evaluation of the massive weight loss patient is useful in predicting complications in the massive weight loss population.
METHODS: 211 consecutive massive weight loss patients (≥50lbs) were identified through our IRB approved prospective registry. All patients were evaluated by a registered dietician and variables collected included age, sex, BMI indices, weight loss method (bariatric surgery vs. self weight loss), time since weight loss, presence of dumping syndrome, dietary protein intake, use of vitamin supplementation and presence of co-morbidities. Laboratory data included a complete blood count, comprehensive metabolic panel, and coagulation profile. Complications were noted for patients who underwent body contouring surgery. Univariate and multivariate logistic regression analyses were performed to determine the association of aforementioned variables and complications.
RESULTS: Of the 211 patients, 75 underwent body contouring procedures. 175 (83%) had a laboratory evaluation, including all 75 patients who underwent body contouring surgery. The overall incidence of abnormal laboratory results ranged from 1%-71% with a low serum globulin being most common (71%). The overall incidence of abnormal lab results was higher in patients who had a higher delta BMI (p=0.03), had bariatric surgery vs. self weight loss (p=0.01) and presence of co-morbidities (p=0.001). When compared to the patients with self weight loss, the patients with bariatric surgery had lower hemoglobin (p=0.03), lower hematocrit (p=0.03), lower total serum protein (p=0.01), lower serum globulin (p=0.05) and lower dietary protein intake (p=0.04). Of the 75 patients who had body contouring surgery, 40 had one or more complications. The overall incidence of complications was higher in patients who had lower dietary protein intake (p=0.04), lower total serum protein (p=0.01), lower total serum globulin (p=0.05) and the presence of co-morbidities (p=0.02).
CONCLUSION: Given the high incidence of abnormal laboratory results and association of complications with lower protein intake, low protein levels and the presence of co-morbidities; especially in patients with bariatric surgery, routine laboratory evaluation along with a detailed nutritional assessment is needed for massive weight-loss patients undergoing body contouring surgery. This will help identify patients at a higher risk of developing complications and ultimately improve outcomes.