Rios-Diaz Arturo J, Morris Martin P, Elfanagely Omar, Cunning Jessica R, Davis Harrison, Shakir Sameer, Broach Robyn B, Fischer John P
From the Division of Plastic Surgery, Department of Surgery, University of Pennsylvania; Department of Surgery, Thomas Jefferson University; and Lewis Katz School of Medicine, Temple University.
Plast Reconstr Surg. 2022 Oct 1;150(4):767e-775e. doi: 10.1097/PRS.0000000000009551. Epub 2022 Jul 26.
Panniculectomy and abdominoplasty are uptrending procedures to address excess skin after weight loss which affects patient-reported quality of life. The authors aimed to identify factors associated with low preoperative quality of life, quantify the benefit of these procedures, and evaluate benefits across grades of obesity.
Patients seeking panniculectomy and abdominoplasty between 2018 and 2019 with a completed preoperative BODY-Q questionnaire were identified. Stratification by quality of life in tertiles for each BODY-Q domain allowed identification of characteristics associated with low quality of life using chi-square tests. Wilcoxon signed-rank tests were used to compare preoperative to postoperative change in quality of life. Differences in quality of life by obesity class (1-2 vs. 3) were ascertained using chi-square tests.
A total of 183 patients completed preoperative quality-of-life questionnaires. Preoperative factors associated with low quality of life included age older than 40 years, Black race, public insurance, hypertension, and American Society of Anesthesiologists class (all p < 0.05). Of patients who completed a preoperative BODY-Q and underwent surgery, 46 (63 percent) completed both surveys. Quality of life improved postoperatively across all domains ( p < 0.01). The presence of a surgical site occurrence (e.g., infection, delayed healing, hematoma, seroma) did not impact postoperative quality of life in any domain ( p > 0.05). Obesity classification did not affect change in quality of life preoperatively to postoperatively ( p > 0.05).
Quality of life is significantly lower at baseline in older, Black, publicly insured patients, and multimorbid patients, but improves dramatically after panniculectomy and abdominoplasty regardless of incidence of complications or degree of obesity. .
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
腹壁成形术和腹部整形术是呈上升趋势的手术，用于解决减肥后多余的皮肤问题，这会影响患者报告的生活质量。作者旨在确定与术前生活质量低下相关的因素，量化这些手术的益处，并评估不同肥胖等级的益处。
确定2018年至2019年间寻求腹壁成形术和腹部整形术且完成术前BODY-Q问卷的患者。通过对每个BODY-Q领域的生活质量进行三分位数分层，使用卡方检验确定与低生活质量相关的特征。采用Wilcoxon符号秩检验比较术前和术后生活质量的变化。使用卡方检验确定不同肥胖等级（1-2级与3级）生活质量的差异。
共有183例患者完成了术前生活质量问卷。与低生活质量相关的术前因素包括年龄大于40岁、黑人种族、公共保险、高血压和美国麻醉医师协会分级（均p<0.05）。在完成术前BODY-Q并接受手术的患者中，46例（63%）完成了两项调查。所有领域的生活质量术后均有改善（p<0.01）。手术部位并发症（如感染、愈合延迟、血肿、血清肿）的出现对任何领域的术后生活质量均无影响（p>0.05）。肥胖分级对术前至术后生活质量的变化无影响（p>0.05）。
年龄较大、黑人、有公共保险的患者以及患有多种疾病的患者在基线时生活质量显著较低，但腹壁成形术和腹部整形术后生活质量显著改善，无论并发症发生率或肥胖程度如何。
临床问题/证据级别：治疗性，IV级。
