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PURPOSE:
Abdominoplasty has been maligned as the plastic surgery procedure with the highest complication rate. To verify the veracity of this criticism, we queried the CosmetAssure® database, looking at complications associated with abdominoplasty this year. Complications data has become an important aspect of improving safety of plastic surgery. The CosmetAssure® database is unique in that patients are enrolled from participating plastic surgeons on a prospective basis, so every case and complication is captured. Futhermore, surgeons and patients are incentivized to report complications because the program reimburses the costs associated with those complications. Therefore, we believe it to be a source for some of the best complications data available to our specialty. The purpose of this study is to determine the incidence of complications and inherent risk factors in abdominoplasty using the CosmetAssure® database.
METHODS:
All abdominoplasties performed from January 1, 2010 through September 22, 2010 were collected from the CosmetAssure® database. The top ten complications occurring after abdominoplasty were ranked by incidence. Potential risk factors, such as BMI, smoking, age, diabetes, and multiple procedures, were analyzed to determine their relationship to the incidence of complications after abdominoplasty.
RESULTS:
A total of 3,681 abdominoplasties were performed from January 1 through September 22, 2010. Of these, 163 patients sustained 173 complications, yielding an overall complication rate of 4.7% (173/3,681). During the same timeframe, a total of 15,311 other cosmetic procedures were performed, resulting in 241 complications for an overall complication rate of 1.57% that was statistically significant (p<0.0001).
Of patients who had complications after abdominoplasty, 60/163 (37%) underwent abdominoplasty as a single procedure, whereas 103/163 (63%) had additional procedures performed at the same time. The average age of patients having abdominoplasty-related complications was 44 years, and the average BMI was 27 kg/m². Of the patients in whom complications arose, 12/163 (7%) were smokers and 7/163 (4%) were diabetic. Single
complications were reported in 155/163 (95%) of patients, whereas 8/163 (5%) had multiple complications.
Abdominoplasty Complications Ranked by Prevalence and Incidence

Rank	Complication	# Complications	% Complications	Complications Incidence
1	Infection	60	35%	1.63%
2	Hemorrhage	43	25%	1.17%
3	PE	12	7%	0.19%
4	Fluid Overload	11	6%	0.33%
5	Rule Out DVT	9	5%	0.30%
6	Hypoxia	8	5%	0.24%
7	Pulmonary Dysfunction	8	5%	0.22%
8	Rule Out PE	8	5%	0.22%
9	Severe Hypotension	6	3%	0.16%
10	DVT	6	3%	0.16%
	TOTAL			4.7%

The most prevalent complication was infection, accounting for 60/173 (35%) complications, followed by hemorrhage 43/173 (25%), PE 12/173 (7%), fluid overload 11/173 (6%), among others.
The incidence of any complication after abdominoplasty was 173/3,681 (4.7%). The incidence of infection was 60/3,681 (1.63%), followed by hemorrhage 43/3,681 (1.17%), PE 12/3,681 (0.33%), fluid overload 11/3,681 (0.30%), among others.
CONCLUSIONS:
Abdominoplasty complications data acquired from the CosmetAssure® database from January 1 through September 22, 2010 demonstrates an overall incidence of complications at 4.7%, which is more than double the complication rate seen in all other cosmetic surgical procedures analyzed during the same time frame. Infection was most common complication, followed by hemorrhage and pulmonary embolism. Collectively, these three complications represent 2/3 of the total complications after abdominoplasty. Using these data, plastic surgeons have a benchmark for complications in abdominoplasty that hopefully can be used in the future to improve patient care.