Body Mass and Surgical Complications in the Postbariatric Reconstructive Patient

In my amateur translation, this study seems to suggest that the bigger you WERE initially, the more complications you might run into during reconstructive plastic surgery.  Seems logical, more skin, more mass overall, more skin breakdown, among all the other things that happen.  I assume also that they mean that people are having plastic surgery before they are no longer obese.


Source:  Annals of Surgery, March 2009

Objective: To analyze the impact of body mass indices on postbariatric reconstructive surgery complications.

Background: An increasing number of
patients are presenting after massive weight loss due to bariatric
surgery or diet and exercise. Many of these patients have residual
obesity, which may compromise outcomes.

Methods: 449 patients were enrolled in a
prospective registry over 6 years. Measures included medical
complications and comorbidities. All cases were analyzed together as
well as in two subgroups: single procedure cases (Group I) and multiple
procedure cases (Group II).

Results: 449 patients (407 female, 42
male) with a mean age of 44.5 ± 10.3 underwent 511 separate operations.
Mean pre-weight loss BMI (Max BMI) was 51.6 ± 9.5 kg/m2,
post-weigh loss BMI (Current BMI) was 29.3 ± 5.0 and the ΔBMI was 22.3
± 7.5. For all cases (n = 511), the presence of a surgical complication
was directly related to Max BMI (P = 0.002) and ΔBMI (P = 0.002) but not Current BMI.

Group I consisted of 194 single procedure cases. Complications in Group I were related to Max BMI (P = 0.006) and Current BMI (P = 0.02) but not ΔBMI. Max BMI impacted infections (P = 0.003) while Current BMI impacted dehiscence (P = 0.009) and infections (P = 0.03). Group II consisted of 317 cases with only ΔBMI directly related to overall complications (P = 0.01).

Conclusions: Body mass indices influence
complications in postbariatric reconstructive surgery. Current BMI may
impact complications in single-procedure cases, but appears to play
less of a role in larger cases. Careful patient selection, assessment
of surgical complexity, and recognition of the particular risks
increased by residual obesity can help to optimize outcomes in this
patient population.

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