Suresh Visakha, Levites Heather, Peskoe Sarah, Hein Rachel, Avashia Yash, Erdmann Detlev
Division of Plastic, Maxillofacial, and Oral Surgery, Department of Surgery, and.
Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, NC.
Ann Plast Surg. 2019 Jul;83(1):94-98. doi: 10.1097/SAP.0000000000001759.
Panniculectomy procedures have been reported to significantly improve quality of life, increase mobility, and improve hygiene in patients with a significant pannus formation. The primary aims of this study were to determine which preoperative risk factors may be used to differentiate postoperative complication rate among patient cohorts and to validate utilization of the American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) risk calculator in patients undergoing panniculectomies.
This retrospective study included all patients who underwent a panniculectomy procedure at our institution from 2005 to 2016. Baseline characteristics, preoperative risk factors, medical comorbidities, and postoperative complications were collected via retrospective chart review.
Two hundred sixty-four patients who underwent a panniculectomy were identified. The odds ratios of any postoperative complication were 8.26, 7.76, and 16.6 for patients with classes 1, 2, and 3 obesity, respectively (P < 0.05). Statistical modeling was utilized to evaluate the predictive performance of the ACS-NSQIP Surgical Risk Calculator. We calculated the C-statistic for the ACS-NSQIP model to be only 0.61, indicating that although the model is associated with the risk of complication, it does not have a strong predictive value for this particular procedure.
This study is one of the first to characterize postoperative complication rate based on extremum of body mass index for panniculectomy patients. Our results show that the utilization of the ACS-NSQIP Risk Calculator in this particular patient population underestimates the complication risk as a whole, which may necessitate the future development of a separate risk assessment model for this procedure.
据报道，腹壁成形术可显著改善生活质量、增强活动能力并改善有明显腹壁赘肉形成患者的卫生状况。本研究的主要目的是确定哪些术前风险因素可用于区分不同患者群体的术后并发症发生率，并验证美国外科医师学会（ACS）国家外科质量改进计划（NSQIP）风险计算器在接受腹壁成形术患者中的应用。
这项回顾性研究纳入了2005年至2016年在我们机构接受腹壁成形术的所有患者。通过回顾病历收集基线特征、术前风险因素、内科合并症和术后并发症。
确定了264例接受腹壁成形术的患者。1级、2级和3级肥胖患者任何术后并发症的比值比分别为8.26、7.76和16.6（P<0.05）。采用统计建模评估ACS-NSQIP手术风险计算器的预测性能。我们计算出ACS-NSQIP模型的C统计量仅为0.61，这表明尽管该模型与并发症风险相关，但对这一特定手术并没有很强的预测价值。
本研究是首批根据腹壁成形术患者体重指数极值来描述术后并发症发生率的研究之一。我们的结果表明，在这一特定患者群体中使用ACS-NSQIP风险计算器总体上低估了并发症风险，这可能需要未来为该手术开发单独的风险评估模型。
