American Association of Plastic Surgeons
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Cosmetic Abdominoplasty Vs Functional Panniculectomy: Pulmonary Embolism Risk
Christopher L. Kalmar, MD MBA, Brian C. Drolet, MD, Salam Kassis, MD, Wesley P. Thayer, MD, Kent K. Higdon, MD, Galen Perdikis, MD.
Vanderbilt University Medical Center, Nashville, TN, USA.

PURPOSE: Increased intraabdominal pressure after cosmetic abdominoplasty may decrease venous return, which we hypothesized may contribute to increased risk of DVT or PE. The purpose of this study was to investigate the relative risk of PE in patients undergoing functional panniculectomy versus cosmetic abdominoplasty.
METHODS: The ACS NSQIP dataset was queried for panniculectomy procedures performed between 2015 and 2019. Excision of excessive infraumbilical tissue was defined as CPT 15830. According to ASPS guidelines, cosmetic abdominoplasty was defined as cases with the ICD-10 Z41.1 or CPT 15847 modifier, while functional panniculectomy was defined as cases without these modifiers. PE occurrence within 30 postoperative days was compared between these cohorts.
RESULTS: During the study interval, 11137 patients underwent excision of excessive infraumbilical tissue, including 57.4% (n=6397) functional panniculectomy and 42.6% (n=4740) cosmetic abdominoplasty. Average age overall was 46.412.1 years, but those undergoing cosmetic abdominoplasty were significantly younger (p<.001, 44.911.5 vs 47.512.3). Average preoperative BMI was 31.78.0 kg/m2, and those undergoing functional panniculectomy had significantly higher BMI (p<.001, 33.38.9 vs 29.56.0).
Patients undergoing cosmetic abdominoplasty were 2.4 times (95%CI 1.3-4.3) more likely to experience postoperative PE than patients undergoing functional panniculectomy (p=.003, 0.6% vs 0.3%).
In multivariate regression, risk for postoperative PE was independently associated with cosmetic abdominoplasty (p<.001, AOR=4.1), elevated BMI (p=.001, AOR=1.3 per 5 kg/m2), and chronic renal failure on dialysis (p=.032, AOR=10.3).
CONCLUSION: Patients undergoing cosmetic abdominoplasty are four times more likely to develop PE in the immediate postoperative period than those undergoing functional panniculectomy.


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