AlQattan Husain T, Mundra Leela S, Rubio Gustavo A, Thaller Seth R
DeWitt Daughtry Family Department of Surgery, University of Miami Leonard M. Miller School of Medicine, Miami, FL, USA.
University of Miami Leonard M. Miller School of Medicine, Miami, FL, USA.
Aesthetic Plast Surg. 2018 Feb;42(1):13-20. doi: 10.1007/s00266-017-0976-y. Epub 2017 Oct 12.
Obesity may increase the risk of complications following abdominal contouring. The aim of this study is to evaluate panniculectomy outcomes in patients with class III obesity (BMI > 40 kg/m).
The American College of Surgeon's National Surgical Quality Improvement Program ACS-NSQIP (2010-2014) was used to identify patients who underwent panniculectomy. Class III obesity patients were identified. Demographics, comorbidities and postoperative outcomes were evaluated. Risk-adjusted multivariate logistic regression analyses were performed to assess impact of class III obesity on panniculectomy outcomes.
A total of 4497 panniculectomies were identified. Of these, 545 (12.1%) were performed in patients with class III obesity. This group was older (mean age 50.3 vs. 45.9, p < 0.01) with a higher proportion of men (23.4 vs. 12.4%, p < 0.01). Class III obesity group also had higher rates of comorbidities (p < 0.01). Postoperatively, class III obesity patients experienced much higher rates of wound complications (17.8 vs. 6.8%), sepsis (3.3 vs. 0.8%), venous thromboembolism (1.5 vs. 0.7%) and medical complications (6.4 vs. 1.8%), p < 0.05. Additionally, this group had higher rates of unplanned reoperation (9.2 vs. 3.7%) and 30-day readmissions (3.5 vs. 1.0%), p < 0.01. On risk-adjusted multivariate regression analyses, class III obesity was independently associated with increased risk of wound complications (OR 2.22, p < 0.01), sepsis (OR 3.53, p < 0.01), medical adverse events (OR 1.98, p < 0.05), unplanned reoperation (OR 1.62, p < 0.05) and 30-day readmission (OR 2.30, p < 0.05).
Class III obesity patients are at significantly increased risk of adverse outcomes following abdominal contouring. Plastic surgeons should consider these risks for counseling and preoperative risk optimization.
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肥胖可能会增加腹部塑形术后并发症的风险。本研究的目的是评估Ⅲ级肥胖（BMI>40kg/m²）患者行腹壁成形术的效果。
利用美国外科医师学会国家外科质量改进计划（ACS-NSQIP，2010 - 2014年）来确定接受腹壁成形术的患者。识别出Ⅲ级肥胖患者。评估其人口统计学特征、合并症及术后结局。进行风险调整的多因素逻辑回归分析，以评估Ⅲ级肥胖对腹壁成形术结局的影响。
共识别出4497例腹壁成形术。其中，545例（12.1%）是在Ⅲ级肥胖患者中进行的。该组患者年龄较大（平均年龄50.3岁对45.9岁，p<0.01），男性比例较高（23.4%对12.4%，p<0.01）。Ⅲ级肥胖组的合并症发生率也更高（p<0.01）。术后，Ⅲ级肥胖患者的伤口并发症发生率（17.8%对6.8%）、脓毒症发生率（3.3%对0.8%）、静脉血栓栓塞发生率（1.5%对0.7%）和医疗并发症发生率（6.4%对1.8%）均显著更高，p<0.05。此外，该组患者的计划外再次手术率（9.2%对3.7%）和30天再入院率（3.5%对1.0%）也更高，p<0.01。在风险调整的多因素回归分析中，Ⅲ级肥胖与伤口并发症风险增加（OR 2.22，p<0.01）、脓毒症风险增加（OR 3.53，p<0.01）、医疗不良事件风险增加（OR 1.98，p<0.05）、计划外再次手术风险增加（OR 1.62，p<0.05）和30天再入院风险增加（OR 2.30，p<0.05）独立相关。
Ⅲ级肥胖患者腹部塑形术后不良结局的风险显著增加。整形外科医生在咨询和术前风险优化时应考虑这些风险。
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