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PURPOSE:
Lower body lifting is an operation used to treat dermatolipodystrophy after massive weight loss and is conventionally done as an inpatient. This study’s purpose is to discern if outpatient lower body lifting can be done safely and effectively.
METHODS:
All outpatients and inpatients treated by the senior author (BAM) who underwent lower body lifting after massive weight loss from July 2000 through May 2011 were studied. With IRB approval, chart reviews were completed, extracting pertinent data for evaluation of complications, results and safety.
RESULTS:
A total of 35 patients were studied, all of whom underwent abdominoplasty and lower body lift; 22 of the 35 had an additional contouring procedure. There with 19 outpatients, either operated upon in an accredited office-based OR suite, or a licensed ambulatory surgery facility. There were 16 inpatients. All patients were provided thromboembolic prophylaxis using sequential compression boots and Heparin or Lovenox on call to surgery and then continued for 2 more days after surgery. Pain control was provided by oral analgesics and bupivicaine pain pump (latter half of the study period). Pertinent data is below:

	#	Age	BMI	F/U days	Cellulitis	Seroma	Hematoma	Wounds	Reoperation	PE/DVT	Transfusions
Outpatient	19	42.75 (25-60)	24.99 (20.2 to 30.5)	66 (18-175)	12 (63%) (oral ABX)	4 (21%)	0	14 (74%) (largest 2cm)	0	0	0
Inpatient	16	40.8 (21 - 61)	30.89 (22.99 to 39.6)	136 (27 to 591)	9 (47%) (oral ABX	5 (31%)	0	10 (62%) (largest 4cm)	6 for wound closure	0	0

Notably: BMI was greater in the inpatient group (p=0.002; chi square value 7.886). No differences were seen in cellulitis (all treated with oral antibiotics), seromas, nor incidence of open wounds. However, the inpatient group tended to have larger open wounds such that 6 required reoperation (p <0.001; chi square value 25.811). All patients in both groups rated personal satisfaction of their results as high or very high.
CONCLUSION:
Lower body lifting is an operation done by most centers as an inpatient procedure. This study shows that this procedure can be done with a high level of safety and efficacy as an outpatient in properly selected patients. This retrospective study indicates a selection bias for outpatient surgery in those with lower BMI. Additionally, use of PREOPERATIVE thromboembolic chemoprophylaxis did not result in hemorrhagic morbidity. An increased incidence of reoperation for wounds was seen in the inpatient group which is most likely attributable to the higher BMI of these patients. Outpatient surgical facilities have significantly lower costs than hospitals. As such, increased use of safe outpatient surgery should increase the availability of more complete contouring for patients who would otherwise be financially precluded.