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Advanced Age Is a Risk Factor for Complications Following Abdominal Panniculectomy

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Abstract

Background

Widespread adoption of bariatric surgery in the treatment of obesity has led to greater numbers of patients seeking panniculectomy, including aged patients, who represent a rapidly growing proportion of the U.S population. Although the quality of life and functional benefits of abdominal panniculectomy have been established, its safety in patients 65 years and older has not been evaluated.

Methods

The American College of Surgeons National Surgical Quality Improvements (ACS-NSQIP) database was used to identify patients undergoing panniculectomy between 2010 and 2015. Age 65 years and older was the risk factor of interest, and primary outcomes included 30-day wound complications, overall complications, reoperation, readmission, and mortality. Multivariate regression was performed to control for confounders.

Results

Review of the database identified 7030 patients who underwent abdominal panniculectomy. When stratified by age, 6455 (91.8%) of patients were younger than 65, and 575 (8.2%) were 65 or older. Multivariate regression analysis demonstrated that age over 65 was a significant independent risk factor for wound complications (OR = 1.81; 95% CI 1.35–2.42; p < 0.001) and all complications (OR = 1.46; 95% CI 1.15–1.87; p = 0.002). BMI, smoking, diabetes, and partial or total dependence were also identified as significant independent risk factors for wound and all complications.

Conclusion

Our analysis demonstrates that advanced age is an independent risk factor for wound and overall complications following abdominal panniculectomy. These results highlight the importance of preoperative evaluation and optimization of modifiable preoperative risk factors as well as close postoperative follow-up for safe outcomes in patients 65 and older.

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References

  1. Gu JK, Charles LE, Bang KM, et al. Prevalence of obesity by occupation among US workers: the National Health Interview Survey 2004–2011. J Occup Environ Med. 2014;56(5):516–28. https://doi.org/10.1097/JOM.0000000000000133.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Almutairi K, Gusenoff JA, Rubin JP. Body contouring. Plast Reconstr Surg. 2016;137(3):586e–602e. https://doi.org/10.1097/PRS.0000000000002140.

    Article  CAS  PubMed  Google Scholar 

  3. Gallagher S, Gates JL. Obesity, panniculitis, panniculectomy, and wound care: understanding the challenges. J Wound Ostomy Continence Nurs. 2003;30(6):334–41. https://doi.org/10.1016/S1071.

    Article  PubMed  Google Scholar 

  4. Jotwani P, Srivastav V, Tripathi M, et al. Free-access open-source e-learning in comprehensive neurosurgery skills training. Neurol India. 2014;62(4):352–61. https://doi.org/10.4103/0028-3886.141208.

    Article  PubMed  Google Scholar 

  5. Potter JF, Burton JR, Drach GW, et al. Geriatrics for residents in the surgical and medical specialties: implementation of curricula and training experiences. J Am Geriatr Soc. 2005;53(3):511–5. https://doi.org/10.1111/j.1532-5415.2005.53173.x.

    Article  PubMed  Google Scholar 

  6. Dasgupta M, Rolfson DB, Stolee P, et al. Frailty is associated with postoperative complications in older adults with medical problems. Arch Gerontol Geriatr. 2009;48(1):78–83. https://doi.org/10.1016/j.archger.2007.10.007.

    Article  PubMed  Google Scholar 

  7. Watt J, Tricco AC, Talbot-Hamon C, et al. Identifying older adults at risk of harm following elective surgery: a systematic review and meta-analysis. BMC Med. 2018;16(1):2. https://doi.org/10.1186/s12916-017-0986-2.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Colloca G, Santoro M, Gambassi G. Age-related physiologic changes and perioperative management of elderly patients. Surg Oncol. 2010;19(3):124–30. https://doi.org/10.1016/j.suronc.2009.11.011.

    Article  PubMed  Google Scholar 

  9. Tang B, Green C, Yeoh AC, et al. Post-operative outcomes in older patients: a single-centre observational study. ANZ J Surg. 2018;88(5):421–7. https://doi.org/10.1111/ans.14433.

    Article  PubMed  Google Scholar 

  10. Matsuo M, Yamagami T, Higuchi A. Impact of age on postoperative complication rates among elderly patients with hip fracture: a retrospective matched study. J Anesth. 2018;32(3):452–6. https://doi.org/10.1007/s00540-018-2494-8.

    Article  PubMed  Google Scholar 

  11. Gerber P, Anderin C, Szabo E, et al. Impact of age on risk of complications after gastric bypass: a cohort study from the Scandinavian obesity surgery registry (SOReg). Surg Obes Relat Dis. 2018;14(4):437–42. https://doi.org/10.1016/j.soard.2017.12.024.

    Article  PubMed  Google Scholar 

  12. Pereira JF, Golijanin D, Pareek G, et al. The association of age with perioperative morbidity and mortality among men undergoing radical prostatectomy. Urol Oncol. 2018;36(4):157 e7–e13. https://doi.org/10.1016/j.urolonc.2017.11.019.

    Article  Google Scholar 

  13. Finlayson EV, Birkmeyer JD. Operative mortality with elective surgery in older adults. Eff Clin Pract. 2001;4(4):172–7.

    CAS  PubMed  Google Scholar 

  14. Arthurs ZM, Cuadrado D, Sohn V, et al. Post-bariatric panniculectomy: pre-panniculectomy body mass index impacts the complication profile. Am J Surg. 2007;193(5):567–70; discussion 70. https://doi.org/10.1016/j.amjsurg.2007.01.006.

    Article  PubMed  Google Scholar 

  15. Derickson M, Phillips C, Barron M, et al. Panniculectomy after bariatric surgical weight loss: analysis of complications and modifiable risk factors. Am J Surg. 2018;215(5):887–90. https://doi.org/10.1016/j.amjsurg.2018.02.008.

    Article  PubMed  Google Scholar 

  16. Barcha CP, Ranzer MJ. Smoking as a risk factor for panniculectomy: an analysis of 7650 cases. J Plast Reconstr Aesthet Surg. 2018;71(5):767–9. https://doi.org/10.1016/j.bjps.2017.12.014.

    Article  PubMed  Google Scholar 

  17. Mioton LM, Buck 2nd DW, Gart MS, et al. A multivariate regression analysis of panniculectomy outcomes: does plastic surgery training matter? Plast Reconstr Surg. 2013;131(4):604e–12e. https://doi.org/10.1097/PRS.0b013e3182818f1f.

    Article  CAS  PubMed  Google Scholar 

  18. Couto RA, Lamaris GA, Baker TA, et al. Age as a risk factor in abdominoplasty. Aesthet Surg J. 2017;37(5):550–6. https://doi.org/10.1093/asj/sjw227.

    Article  PubMed  Google Scholar 

  19. Massenburg BB, Sanati-Mehrizy P, Jablonka EM, et al. Risk factors for readmission and adverse outcomes in abdominoplasty. Plast Reconstr Surg. 2015;136(5):968–77. https://doi.org/10.1097/PRS.0000000000001680.

    Article  CAS  PubMed  Google Scholar 

  20. Winocour J, Gupta V, Ramirez JR, et al. Abdominoplasty: risk factors, complication rates, and safety of combined procedures. Plast Reconstr Surg. 2015;136(5):597e–606e. https://doi.org/10.1097/PRS.0000000000001700.

    Article  CAS  PubMed  Google Scholar 

  21. Yeslev M, Gupta V, Winocour J, et al. Safety of cosmetic procedures in elderly and octogenarian patients. Aesthet Surg J. 2015;35(7):864–73. https://doi.org/10.1093/asj/sjv053.

    Article  PubMed  Google Scholar 

  22. The American College of Surgeons. The American College of Surgeons National Surgical Quality Improvement Program. 2015. https://www.facs.org/quality-programs/acs-nsqip/about. Accessed 1 June 2018.

  23. Chow WB, Rosenthal RA, Merkow RP, et al. Optimal preoperative assessment of the geriatric surgical patient: a best practices guideline from the American College of Surgeons National Surgical Quality Improvement Program and the American Geriatrics Society. J Am Coll Surg. 2012;215(4):453–66. https://doi.org/10.1016/j.jamcollsurg.2012.06.017.

    Article  PubMed  Google Scholar 

  24. Beard J, Officer A, Cassels A. World Report on Ageing and Health. Ageing and life-course, World Health Organization: 2015. 260. http://www.who.int/ageing/events/world-report-2015-launch/en/. Accessed 1 June 2018.

  25. Herman CK, Hoschander AS, Wong A. Post-bariatric body contouring. Aesthet Surg J. 2015;35(6):672–87. https://doi.org/10.1093/asj/sjv008.

    Article  PubMed  Google Scholar 

  26. Acarturk TO, Wachtman G, Heil B, et al. Panniculectomy as an adjuvant to bariatric surgery. Ann Plast Surg. 2004;53(4):360–6. discussion 7

    Article  Google Scholar 

  27. Davis MM, Slish K, Chao C, et al. National trends in bariatric surgery, 1996-2002. Arch Surg. 2006;141(1):71–4; discussion 5. https://doi.org/10.1001/archsurg.141.1.71.

    Article  PubMed  Google Scholar 

  28. Borud LJ, Warren AG. Body contouring in the postbariatric surgery patient. J Am Coll Surg. 2006;203(1):82–93. https://doi.org/10.1016/j.jamcollsurg.2006.01.015.

    Article  PubMed  Google Scholar 

  29. Mitchell JE, Crosby RD, Ertelt TW, et al. The desire for body contouring surgery after bariatric surgery. Obes Surg. 2008;18(10):1308–12. https://doi.org/10.1007/s11695-008-9557-0.

    Article  PubMed  Google Scholar 

  30. Kitzinger HB, Abayev S, Pittermann A, et al. The prevalence of body contouring surgery after gastric bypass surgery. Obes Surg. 2012;22(1):8–12. https://doi.org/10.1007/s11695-011-0459-1.

    Article  PubMed  Google Scholar 

  31. Leahy PJ, Shorten SM, Lawrence WT. Maximizing the aesthetic result in panniculectomy after massive weight loss. Plast Reconstr Surg. 2008;122(4):1214–24. https://doi.org/10.1097/PRS.0b013e31818459ca.

    Article  CAS  PubMed  Google Scholar 

  32. Marengoni A, Angleman S, Melis R, et al. Aging with multimorbidity: a systematic review of the literature. Ageing Res Rev. 2011;10(4):430–9. https://doi.org/10.1016/j.arr.2011.03.003.

    Article  PubMed  Google Scholar 

  33. St Sauver JL, Boyd CM, Grossardt BR, et al. Risk of develo** multimorbidity across all ages in an historical cohort study: differences by sex and ethnicity. BMJ Open. 2015;5(2):e006413. https://doi.org/10.1136/bmjopen-2014-006413.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Kantar RS RW, Wilson SC, David JA, Diaz-Siso JR, Levine JP, Golas AR, Ceradini DJ. Abdominal panniculectomy: determining the impact of diabetes on complications and risk factors for adverse events. Plast Reconst Surg. 2018. https://doi.org/10.1097/PRS.0000000000004732.

  35. Shermak MA, Rotellini-Coltvet LA, Chang D. Seroma development following body contouring surgery for massive weight loss: patient risk factors and treatment strategies. Plast Reconstr Surg. 2008;122(1):280–8. https://doi.org/10.1097/PRS.0b013e31817742a9.

    Article  CAS  PubMed  Google Scholar 

  36. Pluvy I, Garrido I, Pauchot J, et al. Smoking and plastic surgery, part I. Pathophysiological aspects: update and proposed recommendations. Ann Chir Plast Esthet. 2015;60(1):e3–e13. https://doi.org/10.1016/j.anplas.2014.06.011.

    Article  CAS  PubMed  Google Scholar 

  37. Constantine RS, Davis KE, Kenkel JM. The effect of massive weight loss status, amount of weight loss, and method of weight loss on body contouring outcomes. Aesthet Surg J. 2014;34(4):578–83. https://doi.org/10.1177/1090820X14528208.

    Article  PubMed  Google Scholar 

  38. Albino FP, Koltz PF, Gusenoff JA. A comparative analysis and systematic review of the wound-healing milieu: implications for body contouring after massive weight loss. Plast Reconstr Surg. 2009;124(5):1675–82. https://doi.org/10.1097/PRS.0b013e3181b98bb4.

    Article  CAS  PubMed  Google Scholar 

  39. Das S, Forrest K, Howell S. General anaesthesia in elderly patients with cardiovascular disorders: choice of anaesthetic agent. Drugs Aging. 2010;27(4):265–82. https://doi.org/10.2165/11534990-000000000-00000.

    Article  CAS  PubMed  Google Scholar 

  40. Musallam KM, Tamim HM, Richards T, et al. Preoperative anaemia and postoperative outcomes in non-cardiac surgery: a retrospective cohort study. Lancet. 2011;378(9800):1396–407. https://doi.org/10.1016/S0140-6736(11)61381-0.

    Article  PubMed  Google Scholar 

  41. Wu WC, Schifftner TL, Henderson WG, et al. Preoperative hematocrit levels and postoperative outcomes in older patients undergoing noncardiac surgery. JAMA. 2007;297(22):2481–8. https://doi.org/10.1001/jama.297.22.2481.

    Article  CAS  PubMed  Google Scholar 

  42. Turrentine FE, Wang H, Simpson VB, et al. Surgical risk factors, morbidity, and mortality in elderly patients. J Am Coll Surg. 2006;203(6):865–77. https://doi.org/10.1016/j.jamcollsurg.2006.08.026.

    Article  Google Scholar 

  43. Zavlin D, Jubbal KT, Balinger CL, et al. Impact of metabolic syndrome on the morbidity and mortality of patients undergoing panniculectomy. Aesthet Plast Surg. 2017;41(6):1400–7. https://doi.org/10.1007/s00266-017-0952-6.

    Article  Google Scholar 

  44. Sgonc R, Gruber J. Age-related aspects of cutaneous wound healing: a mini-review. Gerontology. 2013;59(2):159–64. https://doi.org/10.1159/000342344.

    Article  PubMed  Google Scholar 

  45. Greenhalgh DG. Management of the skin and soft tissue in the geriatric surgical patient. Surg Clin North Am. 2015;95(1):103–14. https://doi.org/10.1016/j.suc.2014.09.008.

    Article  PubMed  Google Scholar 

  46. Pestana IA, Campbell D, Fearmonti RM, et al. “Supersize” panniculectomy: indications, technique, and results. Ann Plast Surg. 2014;73(4):416–21. https://doi.org/10.1097/SAP.0b013e31827f5496.

    Article  CAS  PubMed  Google Scholar 

  47. Staalesen T, Elander A, Strandell A, et al. A systematic review of outcomes of abdominoplasty. J Plast Surg Hand Surg. 2012;46(3–4):139–44. https://doi.org/10.3109/2000656X.2012.683794.

    Article  PubMed  Google Scholar 

  48. Ardehali B, Fiorentino F. A meta-analysis of the effects of abdominoplasty modifications on the incidence of postoperative seroma. Aesthet Surg J. 2017;37(10):1136–43. https://doi.org/10.1093/asj/sjx051.

    Article  PubMed  Google Scholar 

  49. Manahan MA, Shermak MA. Massive panniculectomy after massive weight loss. Plast Reconstr Surg. 2006;117(7):2191–7; discussion 8-9. https://doi.org/10.1097/01.prs.0000218174.89832.78.

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Hansjörg Wyss Department of Plastic Surgery, New York University Langone Medical Center, 540 1st Avenue, Lab 2-3, New York, NY, 10016, USA

    Michael J. Cammarata, Rami S. Kantar, William J. Rifkin, Jason A. Greenfield, Jamie P. Levine & Daniel J. Ceradini

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  1. Michael J. Cammarata
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  2. Rami S. Kantar
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Correspondence to Daniel J. Ceradini.

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Cammarata, M.J., Kantar, R.S., Rifkin, W.J. et al. Advanced Age Is a Risk Factor for Complications Following Abdominal Panniculectomy. OBES SURG 29, 426–433 (2019). https://doi.org/10.1007/s11695-018-3492-5

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