Schafer Rachel E, Blazel Madeleine M, Nowacki Amy S, Schwarz Graham S
Aesthet Surg J. 2023 Oct 13;43(11):1384-1392. doi: 10.1093/asj/sjad124.
Combining multiple surgical procedures into a single operative session is widespread in the field of plastic surgery; however, the implications of this practice are not fully understood.
This study compared 30-day complication rates associated with combined plastic surgery procedures with the rates for index procedures.
This retrospective cohort analysis utilized the Tracking Operations and Outcomes for Plastic Surgeons database from 2016 to 2020 to identify the 3 most frequent combinations of augmentation mammaplasty, reduction mammaplasty, trunk liposuction, mastopexy, and abdominoplasty.
The 30-day overall complication rate was 5.0% (1400 of 26,771 patients), with a higher complication rate for combined procedures compared with index (7.6% vs 4.2%, adjusted odd ratio [aOR], 1.91 [95% CI, 1.61-2.27], P < .001). There were no significant differences in complication rates for abdominoplasty or mastopexy combinations compared with index. Complication rates for reduction mammaplasty combinations compared with index were not statistically different after controlling for demographics (aOR, 1.02 [95% CI, 0.61-1.64], P = .93). Higher rates of minor and major complications were observed for combinations of trunk liposuction (aOR, 4.84 [95% CI, 3.31-7.21), P < .001) and augmentation mammaplasty (aOR, 1.60 [95% CI 1.13-2.22], P = .007) compared with index.
Combinations with trunk liposuction or augmentation mammaplasty present with increased risk of complications compared with index, controlling for demographics. Abdominoplasty and mastopexy may be combined with other plastic surgery procedures without increased risk to patients. The complication risk of reduction mammaplasty combinations is mediated by other variables, suggesting the need for shared surgical decision-making when recommending these combinations to patients.
在整形手术领域，将多种外科手术合并在一次手术中进行的情况很普遍；然而，这种做法的影响尚未完全明了。
本研究比较了整形手术联合手术与初次手术的30天并发症发生率。
这项回顾性队列分析利用了2016年至2020年整形外科医生手术追踪与结果数据库，以确定隆乳术、缩乳术、躯干吸脂术、乳房上提术和腹壁成形术最常见的3种联合方式。
30天总体并发症发生率为5.0%（26771例患者中的1400例），联合手术的并发症发生率高于初次手术（7.6%对4.2%，校正比值比[aOR]为1.91[95%CI，1.61 - 2.27]，P <.001）。与初次手术相比，腹壁成形术或乳房上提术联合手术的并发症发生率无显著差异。在控制人口统计学因素后，缩乳术联合手术与初次手术相比的并发症发生率无统计学差异（aOR为1.02[95%CI，0.61 - 1.64]，P = 0.93）。与初次手术相比，躯干吸脂术联合手术（aOR为4.84[95%CI，3.31 - 7.21]，P <.001）和隆乳术联合手术（aOR为1.60[95%CI，1.13 - 2.22]，P = 0.007）的轻微和严重并发症发生率更高。
在控制人口统计学因素后，与初次手术相比，躯干吸脂术或隆乳术联合手术的并发症风险增加。腹壁成形术和乳房上提术可与其他整形手术联合进行，而不会增加患者风险。缩乳术联合手术的并发症风险受其他变量影响，这表明在向患者推荐这些联合手术时需要共同进行手术决策。
