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2009 Annual Meeting Abstracts

Risk Analysis for Combined Procedures in Body Contouring after Massive Weight Loss
Mark A. Bishara, MD1, Kristen Rezak, MD2, Samuel J. Lin, MD1, Loren Borud, MD1.
1Beth Israel Deaconess Medical Center, Boston, MA, USA, 2Cleveland Clinic Florida, Weston, FL, USA.

Risk Analysis for Combined Procedures in Body Contouring after Massive Weight Loss

Purpose: Combining several body contouring procedures into a larger one-stage or two-stage operation is a matter of controversy among post-bariatric body contouring surgeons. Some experts assert that combination procedures are associated with higher complication rates, increased risks of pulmonary embolism, and prolonged operating times. The authors compare their experience with combination procedures to their experience with multi-staged procedures to determine whether more aggressive combining strategies are associated with greater risk.
Methods: A retrospective chart review was undertaken on a single surgeon’s 246 consecutive massive weight loss (MWL) patients undergoing various combinations of body contouring procedures from December 2002 through June 2008. Complex-combined, combined, and standard groups of procedures were evaluated to determine if an increase in major or minor complications existed with an increase in number of procedures performed in a single operation. Major complications were defined by readmission to hospital, take back to operating room for incision and drainage, DVT and pulmonary embolism. Minor events included T junction dehiscence of 1 cm or more, wound infection treated non operatively, seroma, lymphocele, cellulites, persistent pain, and scar contracture.
Results: 246 consecutive patients were divided into 3 groups of combinations of procedures; complex-combined (1), combined (2), and standard (3). 24 patients were included in the complex-combined group which was defined by 4 or more procedures or the lower body lift with 2 or more procedures. 38 patients were included in the combined group which was defined by 3 procedures or lower body lift with 1 additional procedure. 182 patients were included in the standard group was defined by no more than 2 procedures in a single operation.
Mean body mass index was not significantly different (p=.14). Minor events were present in 50%, 73.6%, and 46% in groups 1, 2, and 3 respectively, (p =0.3). Wound infection rates including small dehiscence of 1 cm or more were 33%, 24%, and 34% for groups 1, 2, and 3 respectively and were not significantly different (p=0.459). Major complications were present in 12.5%, 14.3%, and 4.4% (chi square = 5.47) in groups 1, 2, and 3 respectively, (p =0.065). DVT was present once in each group. A single pulmonary embolism was identified in the combined group resulting in an additional 5 day hospital stay.
Conclusions: Combining several procedures into a larger single or two-stage stage operation is not associated with an increased complication rate when compared with performing each operation separately. Major and minor events are not significantly different in patients who undergo multiple procedures in 1 operation. For selected patients, combination surgery is as safe as the combined risk of performing procedures in multiple stages. In our series, many patients were attracted to the combined procedure approach because it involves one single recovery, compared with multiple recovery periods, multiple times off work and multiple general anesthetics.

Mean BMIMale:FemaleMean OR TimeTransfusionMinor Complications (%)Major Complications (%)
Group 1 (n=24)28.31:47:50105012.5
Group 2 (n=38)30.51:114:54173.614.3
Group 3 (n=184)311:65:214464.4


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