Makarawung D J S, Al Nawas M, Smelt H J M, Monpellier V M, Wehmeijer L M, van den Berg W B, Hoogbergen M M, Mink van der Molen A B
Department of Plastic, Reconstructive and Hand Surgery, St. Antonius hospital, Koekoekslaan 1, 3435 CM, Nieuwegein, the Netherlands.
Department of General Surgery, Catharina Hospital, Michelangelolaan 2, 5623 EJ, Eindhoven, the Netherlands.
JPRAS Open. 2022 Jun 29;34:91-102. doi: 10.1016/j.jpra.2022.06.006. eCollection 2022 Dec.
Post-bariatric body contouring surgery (BCS) treats redundant skin after massive weight loss; however, the complication risk is relatively high (23-70%). Most complications are wound-related, which may be partly due to a poor nutritional status after bariatric surgery. The objective of this observational study was to optimise nutrition preoperatively and assess the prevalence of wound-related complications after BCS.
This prospective cohort study included 140 patients. Patients were treated according to the post-bariatric BCS guideline. Nutritional parameters were collected via pre- and peri-operative blood sampling; any deficiencies were treated. A protein-enriched diet was prescribed by a dietician 4 weeks preoperatively up until closure of all wounds. Complications were recorded using the Clavien-Dindo classification. Univariate and multivariate regression analyses were performed to identify variables associated with wound-related complications.
The overall wound-related complication rate was 51%. Most complications were minor, with only 4.3% was considered major. No significant differences in patient characteristics were found between patients with and without complications. Variables indicating an optimised nutritional state were not significantly associated with a decreased risk of complications; the most influential factor was a sufficient post-operative protein intake (OR 0.27, 95% CI 0.07 - 1.02, p = 0.05).
The overall wound-related complication rate was in accordance with previous literature; however, major complications were few. This study showed a weak correlation between optimising nutritional state and better outcome after BCS, especially following a protein-enriched diet post-operatively. Therefore, we recommend continuing research on nutrition and wound-related complications, using homogeneous study populations and well-defined complications.
减重后身体塑形手术（BCS）用于治疗大量减重后的皮肤松弛；然而，其并发症风险相对较高（23%-70%）。大多数并发症与伤口相关，这可能部分归因于减重手术后营养状况不佳。这项观察性研究的目的是术前优化营养并评估BCS后伤口相关并发症的发生率。
这项前瞻性队列研究纳入了140例患者。患者按照减重后BCS指南进行治疗。通过术前和围手术期采血收集营养参数；对任何缺乏情况进行治疗。术前4周直至所有伤口愈合，由营养师开具富含蛋白质的饮食处方。使用Clavien-Dindo分类法记录并发症。进行单因素和多因素回归分析以确定与伤口相关并发症相关的变量。
总体伤口相关并发症发生率为51%。大多数并发症为轻微并发症，只有4.3%被认为是严重并发症。有并发症和无并发症的患者在患者特征方面未发现显著差异。表明营养状态优化的变量与并发症风险降低无显著相关性；最有影响的因素是术后充足的蛋白质摄入量（OR 0.27，95%CI 0.07 - 1.02，p = 0.05）。
总体伤口相关并发症发生率与先前文献一致；然而，严重并发症较少。这项研究表明，优化营养状态与BCS后更好的结果之间存在弱相关性，尤其是术后采用富含蛋白质的饮食。因此，我们建议使用同质研究人群和明确界定的并发症继续开展关于营养与伤口相关并发症的研究。
