Elfanagely Omar, Rios-Diaz Arturo J, Cunning Jessica R, Othman Sammy, Morris Martin, Messa Charles, Broach Robyn B, Fischer John P
From the Division of Plastic Surgery, Department of Surgery, University of Pennsylvania; Department of Surgery, Rutgers Robert Wood Johnson Medical School; and Department of Surgery, Thomas Jefferson University.
Plast Reconstr Surg. 2022 Jun 1;149(6):1338-1347. doi: 10.1097/PRS.0000000000009098. Epub 2022 Apr 5.
Massive weight loss after bariatric surgery can lead to excess skin associated with functional and aesthetic sequelae. Access to the benefit provided by body contouring procedures may be limited by insurance approval, which does not consider health-related quality of life. The aim of this study was to quantify the benefit in health-related quality of life for patients who undergo body contouring procedures after massive weight loss.
Patients evaluated for postbariatric body contouring procedures were systematically identified and prospectively surveyed using the BODY-Q. Health-related quality-of-life change for each functional scale was compared between those who underwent body contouring procedures (operative group, preoperatively versus postoperatively) and those who did not (nonoperative group, preoperatively versus resurvey) using t tests. Propensity score matching allowed the authors to balance baseline demographics, comorbidities, physical symptoms, and risk factors between cohorts.
Fifty-seven matched patients were analyzed (34 operative versus 23 nonoperative). No significant difference in age, body mass index, time between surveys, or preoperative BODY-Q scores existed between cohorts. The surgical group demonstrated a significant improvement in 10 out of 11 BODY-Q functional scales. The nonoperative group realized no improvements and, in the interim, had a significant deterioration in four BODY-Q scales.
Postbariatric body contouring procedures represent a critical and final step in the surgical weight loss journey for patients and are associated with significant improvements in health-related quality of life. Further deterioration in psychosocial and sexual health-related quality of life occurs in patients who do not undergo body contouring procedures following bariatric surgery. This study provides prospective comparative data that validate the field's standard intervention and justification for insurance approval.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, II.
减肥手术后的大量体重减轻会导致皮肤过多，从而产生功能和美学后遗症。身体塑形手术带来的益处可能会受到保险批准的限制，而保险批准并不考虑与健康相关的生活质量。本研究的目的是量化大量体重减轻后接受身体塑形手术的患者在与健康相关的生活质量方面的益处。
系统识别接受减肥后身体塑形手术评估的患者，并使用BODY-Q进行前瞻性调查。使用t检验比较接受身体塑形手术的患者（手术组，术前与术后）和未接受手术的患者（非手术组，术前与再次调查）在每个功能量表上与健康相关的生活质量变化。倾向得分匹配使作者能够平衡队列之间的基线人口统计学、合并症、身体症状和风险因素。
分析了57例匹配患者（34例手术组与23例非手术组）。队列之间在年龄、体重指数、调查间隔时间或术前BODY-Q评分方面没有显著差异。手术组在11个BODY-Q功能量表中的10个上有显著改善。非手术组没有改善，并且在此期间，在4个BODY-Q量表上有显著恶化。
减肥后身体塑形手术是患者手术减肥过程中的关键和最后一步，并且与健康相关生活质量的显著改善相关。减肥手术后未接受身体塑形手术的患者在心理社会和性健康相关生活质量方面会进一步恶化。本研究提供了前瞻性比较数据，验证了该领域的标准干预措施以及保险批准的合理性。
临床问题/证据水平：治疗性，II级。
