|2009 Annual Meeting Abstracts
Evaluation of Preoperative Risk Factors and Infection Rates in Cosmetic Abdominoplasty
Michael S. Hanemann, Jr., MD, James C. Grotting, MD, FACS.
Grotting Plastic Surgery, Birmingham, AL, USA.
To assess the relationships between elevated BMI, smoking, and diabetes and postoperative infections following abdominoplasty, based on patient claims made to CosmetAssure, a program which provides coverage for treatment of significant complications which would not be reimbursed by patients’ primary health insurance carriers.
Infection rates were reviewed from 89,888 consecutive CosmetAssure covered procedures, from its inception in June 2003 to February 2008. 13,546 of these were abdominoplasties. We then assessed risk factors of Body Mass Index (BMI) ≥30, smoking, and diabetes in 2,886 patients undergoing abdominoplasty from April 1, 2008, to October 31, 2008.
Because this insurance program reimburses patients for costs associated with the treatment of postsurgical complications, physicians are incentivized to report significant complications. Its claims records provide accurate, unbiased data for determining the significant complication rate for a given cosmetic procedure.
A “significant” infection is defined as a postsurgical infectious complication, occurring within 30 days of the procedure, that requires admission to a hospital, emergency room, or surgery center. Minor infections that were treated in the outpatient setting are not included, as their treatment did not generate an insurance claim. A summary is presented in the following tables:
Table 1: June 2003 - February 2008
|Procedure||Number of patients||% of Total Procedures (17)||# of Infection Related Claims||% of Infection Related Claims||Infection Rate - (% of cases which filed a claim)|
* Includes data for all 17 surgical procedures covered by CosmetAssure
In evaluating 13,546 consecutive abdominoplasties from 2003 to 2008, the infection rate was found to be 0.6%. Abdominoplasty accounted for 43% of significant infectious complications.
Table 2: April 2008 - October 2008
|Number of pts||Complication rate||Pts with BMI≥30 *||Smokers||Diabetics|
* BMI recorded for the most recent 2202 patients
Table 3: April 2008 - October 2008
|BMI ≥ 30||BMI < 30||Smoker||Nonsmoker||Diabetic||Nondiabetic|
|Complication rate (all)||5.10 %||3.37 %||2.21 %||2.93 %||6.33 %||2.78 %|
|Infection Rate||1.37 %||0.89 %||0.88 %||0.75 %||1.28 %||0.9 %|
According to claims data from 4/1/08 to 10/31/08, the infection rate for abdominoplasty was 0.76%. This is slightly higher than the infection rate of 0.6% noted from the previous data set. We noticed a trend that patients with BMI ≥ 30, smokers, and diabetics had higher infection rates than those without risk factors. There was also a trend that patients with BMI ≥ 30 and diabetics had higher overall complication rates. Data collection is ongoing, and as the number of cases increases (approximately 400 new abdominoplasties per month), these trends will likely achieve statistical significance.
Analysis of CosmetAssure data can accurately and objectively track the rate of significant postoperative complications secondary to cosmetic surgical procedures. Of the 17 surgical procedures covered by this program, abdominoplasty is associated with the highest overall complication rate (2.88%), and an infection rate of 0.76%. More data is needed to determine the significance of elevated BMI, smoking, and diabetes as risk factors for complications in cosmetic abdominoplasty.