Chow Ian, Alghoul Mohammed S, Khavanin Nima, Hanwright Philip J, Mayer Kristen E, Hume Keith M, Murphy Robert X, Gutowski Karol A, Kim John Y S
Chicago, Ill.; and Allentown, Pa. From the Division of Plastic and Reconstructive Surgery, Northwestern University, Feinberg School of Medicine; the American Society of Plastic Surgeons; Cosmetic & Reconstructive Specialists of the Lehigh Valley, Lehigh Valley Health Network; and the Division of Plastic Surgery, University of Illinois.
Plast Reconstr Surg. 2015 Sep;136(3):474-483. doi: 10.1097/PRS.0000000000001498.
No concrete data exist to support a specific volume at which liposuction becomes unsafe; surgeons rely on their own estimates, professional organization advisories, or institutional or government-imposed restrictions. This study represents the first attempt to quantify the comprehensive risk associated with varying liposuction volumes and its interaction with body mass index.
Suction-assisted lipectomies were identified from the Tracking Operations and Outcomes for Plastic Surgeons database. Multivariate regression models incorporating the interaction between liposuction volume and body mass index were used to assess the influence of liposuction volume on complications and to develop a tool that returns a single adjusted odds ratio for any combination of body mass index and liposuction volume. Recursive partitioning was used to determine whether exceeding a threshold in liposuction volume per body mass index unit significantly increased complications.
Sixty-nine of 4534 patients (1.5 percent) meeting inclusion criteria experienced a postoperative complication. Liposuction volume and body mass index were significant independent risk factors for complications. With progressively higher volumes, increasing body mass index reduced risk (OR, 0.99; 95 percent CI, 0.98 to 0.99; p = 0.007). Liposuction volumes in excess of 100 ml per unit of body mass index were an independent predictor of complications (OR, 4.58; 95 percent CI, 2.60 to 8.05; p < 0.001).
Liposuction by board-certified plastic surgeons is safe, with a low risk of life-threatening complications. Traditional liposuction volume thresholds do not accurately convey individualized risk. The authors' risk assessment model demonstrates that volumes in excess of 100 ml per unit of body mass index confer an increased risk of complications.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
目前尚无具体数据支持吸脂量达到何种程度会变得不安全；外科医生依靠自己的估计、专业组织的建议或机构或政府规定的限制。本研究首次尝试量化不同吸脂量相关的综合风险及其与体重指数的相互作用。
从整形外科医生手术追踪与结果数据库中识别出吸脂辅助抽脂术。使用纳入吸脂量与体重指数相互作用的多变量回归模型来评估吸脂量对并发症的影响，并开发一种工具，可为体重指数和吸脂量的任何组合返回单一调整后的比值比。采用递归划分法确定每单位体重指数的吸脂量超过阈值是否会显著增加并发症。
4534例符合纳入标准的患者中有69例（1.5%）发生术后并发症。吸脂量和体重指数是并发症的重要独立危险因素。随着吸脂量逐渐增加，体重指数升高可降低风险（比值比，0.99；95%置信区间，0.98至0.99；P = 0.007）。每单位体重指数的吸脂量超过100 ml是并发症的独立预测因素（比值比，4.58；95%置信区间，2.60至8.05；P < 0.001）。
由获得委员会认证的整形外科医生进行的吸脂手术是安全的，危及生命的并发症风险较低。传统的吸脂量阈值不能准确传达个体风险。作者的风险评估模型表明，每单位体重指数的吸脂量超过100 ml会增加并发症风险。
临床问题/证据水平：治疗性，III级。
