Altieri Maria S, Yang Jie, Park Jihye, Novikov David, Kang Lijuan, Spaniolas Konstantinos, Bates Andrew, Talamini Mark, Pryor Aurora
Division of Bariatric, Foregut and Advanced Gastrointestinal Surgery, Department of Surgery, Stony Brook University Medical Center, 100 Nichols Road, HSC T19, Stony Brook, NY, 11794, USA.
Department of Family, Population and Preventive Medicine, Stony Brook University Medical Center, Stony Brook, NY, USA.
Obes Surg. 2017 Nov;27(11):2981-2987. doi: 10.1007/s11695-017-2732-4.
Bariatric surgery has substantial health benefits; however, some patients desire body contouring (BC) procedures following rapid weight loss. There is a paucity of data regarding the true rate of BC following bariatric procedures. The purpose of our study is to examine the utilization of two common procedures, abdominoplasty, and panniculectomy, following bariatric surgery in New York State.
The SPARCS longitudinal administrative database was used to identify bariatric procedures by using ICD-9 and CPT codes between 2004 and 2010. Procedures included sleeve gastrectomy, Roux-en-Y gastric bypass, and laparoscopic adjustable gastric banding. Using a unique patient identifier, we tracked those patients who subsequently underwent either abdominoplasty or panniculectomy with at least a 4-year follow-up (until 2014). Multivariable Cox proportional hazard model was used to evaluate predictors of follow-up BC surgery.
37,806 patients underwent bariatric surgery between 2004 and 2010. Only 5.58% (n = 2112) of these patients subsequently had a BC procedure, with 143 of them (6.8%) having ≥1 plastic surgery. The average time to plastic surgery after band, bypass, or sleeve was 1134.83 ± 671.09, 984.70 ± 570.53, and 903.02 ± 497.31 days, respectively (P < 0.0001). Following the multivariable Cox proportional hazard model, a female, SG patients, patients with Medicare or Medicaid, and patients in either <20 or >80%ile in yearly income were more likely to have plastic surgery after adjusting for age, race/ethnicity, comorbidities and complications (P values < 0.0001).
This study shows that plastic surgery is completed by only 6% of patients following bariatric procedures. As insurance and income are associated with pursuing surgery, improved access may increase the number of patients who are able to undergo these reconstructive procedures.
减肥手术对健康有诸多益处；然而，一些患者在快速减重后希望进行身体塑形（BC）手术。关于减肥手术后真正的身体塑形率的数据匮乏。我们研究的目的是调查纽约州减肥手术后两种常见手术——腹壁成形术和腹部赘肉切除术的应用情况。
利用SPARCS纵向管理数据库，通过使用2004年至2010年间的ICD - 9和CPT编码来识别减肥手术。手术包括袖状胃切除术、Roux - en - Y胃旁路术和腹腔镜可调节胃束带术。使用唯一的患者标识符，我们追踪了那些随后接受腹壁成形术或腹部赘肉切除术且至少随访4年（直至2014年）的患者。采用多变量Cox比例风险模型来评估后续身体塑形手术的预测因素。
2004年至2010年间有37806例患者接受了减肥手术。这些患者中只有5.58%（n = 2112）随后进行了身体塑形手术，其中143例（6.8%）进行了≥1次整形手术。接受束带术、旁路术或袖状胃切除术后进行整形手术的平均时间分别为1134.83±671.09天、984.70±570.53天和903.02±497.31天（P < 0.0001）。在多变量Cox比例风险模型分析后发现，女性、接受袖状胃切除术的患者、有医疗保险或医疗补助的患者以及年收入处于最低20%或最高80%的患者，在调整年龄、种族/民族、合并症和并发症后更有可能进行整形手术（P值< 0.0001）。
本研究表明，减肥手术后只有6%的患者完成了整形手术。由于保险和收入与寻求手术相关，改善获取途径可能会增加能够接受这些重建手术的患者数量。
