Laspro Matteo, Cassidy Michael F, Brydges Hilliard T, Barrow Brooke, Stead Thor S, Tran David L, Chiu Ernest S
From the Hansjörg Wyss Department of Plastic Surgery, New York University Grossman School of Medicine.
Division of Plastic and Reconstructive Surgery, Department of Surgery, Icahn School of Medicine at Mount Sinai.
Plast Reconstr Surg. 2024 Oct 1;154(4):880-889. doi: 10.1097/PRS.0000000000011179. Epub 2023 Nov 3.
Overhanging pannus may be detrimental to ambulation, urination, sexual function, and social well-being. Massive weight loss patients often have high residual body mass index (BMI) and comorbidities presenting a unique challenge in panniculectomy patient selection. This study aims to better characterize the role of BMI in postoperative complications following panniculectomy.
A meta-analysis attempted to assess the impact of BMI on complications following panniculectomy. Cochrane Q and I2 test statistics measured study heterogeneity, with subsequent random effects meta-regression investigating these results. After this, all panniculectomy patients in the National Surgical Quality Improvement Program database in the years 2007 to 2019 were analyzed. Univariate and multivariable tests assessed the relative role of BMI on 30-day postoperative complications.
Thirty-four studies satisfied inclusion criteria, revealing very high heterogeneity (Cochrane Q = 2453.3; I2 = 99.1%), precluding further meta-analysis results. Receiver operating characteristic curves demonstrated BMI was a significant predictor of both all causes (area under the curve, 0.64; 95% CI, 0.62 to 0.66) and wound complications (area under the curve, 0.66; 95% CI, 0.63 to 0.69). BMI remained significant following multivariable regression analyses. Restricted cubic spines demonstrated marginal increases in complication incidence above 33.2 and 35 kg/m 2 for all-cause and wound complications, respectively.
Reported literature regarding postoperative complications in panniculectomy patients is highly heterogeneous and may limit evidence-based care. Complication incidence positively correlated with BMI, although the receiver operating characteristic curve demonstrated its limitations as the sole predictive variable. Furthermore, restricted cubic splines demonstrated diminishing marginal predictive capacity of BMI for incremental increases in BMIs above 33.2 to 35 kg/m 2 . These findings support a reevaluation of the role of BMI cutoffs in panniculectomy patient selection.
悬垂的 pannus 可能对行走、排尿、性功能和社会福祉有害。大量减重患者通常具有较高的残余体重指数（BMI）和合并症，这在腹壁成形术患者选择中带来了独特的挑战。本研究旨在更好地描述 BMI 在腹壁成形术后并发症中的作用。
一项荟萃分析试图评估 BMI 对腹壁成形术后并发症的影响。Cochrane Q 和 I² 检验统计量用于衡量研究异质性，随后进行随机效应荟萃回归分析这些结果。在此之后，对 2007 年至 2019 年国家外科质量改进计划数据库中的所有腹壁成形术患者进行分析。单变量和多变量检验评估了 BMI 对术后 30 天并发症的相对作用。
34 项研究符合纳入标准，显示出非常高的异质性（Cochrane Q = 2453.3；I² = 99.1%），排除了进一步的荟萃分析结果。受试者工作特征曲线表明，BMI 是所有原因（曲线下面积，0.64；95% CI，0.62 至 0.66）和伤口并发症（曲线下面积，0.66；95% CI，0.63 至 0.69）的重要预测指标。多变量回归分析后，BMI 仍然具有显著性。限制立方样条显示，对于所有原因和伤口并发症，BMI 分别高于 33.2 和 35 kg/m² 时，并发症发生率略有增加。
关于腹壁成形术患者术后并发症的报道文献高度异质性，可能会限制循证护理。并发症发生率与 BMI 呈正相关，尽管受试者工作特征曲线显示其作为唯一预测变量存在局限性。此外，限制立方样条表明，对于 BMI 在 33.2 至 35 kg/m² 以上的增量增加，BMI 的边际预测能力逐渐减弱。这些发现支持重新评估 BMI 临界值在腹壁成形术患者选择中的作用。
