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Evolution Of Clinical Practice Patterns In Liposuction: A Sixteen-year Review Of Continuous Certification Tracer Data From The American Board Of Plastic Surgery
Daniel C. Sasson, BA1, Michael J. Stein, MD, FRCSC2, John J. Harrast, PhD3, Amy Alderman, MD, MPH, FACS4, Alan Matarasso, MD, FACS2, Arun K. Gosain, MD, FACS1.
1Division of Plastic Surgery, Ann and Robert H. Lurie Children's Hospital, Chicago, IL, USA, 2Department of Plastic and Reconstructive Surgery, Lenox Hill Hospital, New York, NY, USA, 3Data Harbor Solutions, Chicago, IL, USA, 4American Board of Plastic Surgery, Philadelphia, PA, USA.

Purpose
A sixteen-year review of liposuction tracer data collected from diplomates of the American Board of Plastic Surgery (ABPS) as part of the Continuous Certification process was performed to evaluate for predominant practice patterns and changes in specific practice patterns over this time.
Methods
Liposuction tracer data were collected from 2005-2021, comparing tracer data from 2005-2014 to those from 2015-2021 using Fisher's exact test and Student's t-test.
Results
2810 patients with an average age of 42 years were evaluated, of which 84% were female. In the later cohort (2015-2021), in-office procedures increased significantly (Table 1). Concerning the body area of liposuction, abdomen, flank, and back have increased, while thighs and knees have decreased. Power-assisted lipectomy has grown in popularity, and significant increases were noted in the volume of wetting solution and lipoaspirate. Surgeons are performing procedures concomitantly with liposuction more often, and more mid-surgical position changes from prone to supine were noted. Perioperative heparin and low-molecular-weight heparin (LMWH) use have significantly increased.

Table 1: Trends in liposuction practice patterns from the ABPS tracer data (n = 2810).
Procedure Characteristic2005-2014 (n = 1150)2015-2021 (n = 1660)P-valueProcedure Characteristic2005-2014 (n = 1150)2015-2021 (n = 1660)P-value
1. In-office procedures36%41%< 0.0110. Lipoaspirate volume2076cc2363cc< 0.0001
2. Location: Abdomen64%69%< 0.0111. Concomitant procedures28%36%< 0.0001
3. Location: Flank60%64%< 0.0512. Mid-surgical position change from prone to supine30%37%< 0.0001
4. Location: Back22%34%< 0.000113. Perioperative heparin/LMWH2%7%< 0.0001
5. Location: Thighs36%23%< 0.0001
6. Location: Knees8%5%< 0.01
7. Technique: Power-assisted lipectomy24%40%< 0.0001
8. Technique: Traditional lipectomy50%40%< 0.0001
9. Wetting solution volume2425cc2808cc< 0.0001

Conclusions
The present study is the first to objectively assess evolving trends in the clinical practice of liposuction over the last sixteen years. These data illustrate an increase in outpatient procedures, a shift in technique towards power-assisted liposuction, and greater surgical focus on the trunk (abdomen, flanks, and back).


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