The Impact of Body Mass Index on Adverse Outcomes Associated with Panniculectomy: A Multimodal Analysis.

Autor:	Laspro M; From the Hansjörg Wyss Department of Plastic Surgery, New York University Grossman School of Medicine., Cassidy MF; From the Hansjörg Wyss Department of Plastic Surgery, New York University Grossman School of Medicine., Brydges HT; From the Hansjörg Wyss Department of Plastic Surgery, New York University Grossman School of Medicine., Barrow B; Division of Plastic and Reconstructive Surgery, Department of Surgery, Icahn School of Medicine at Mount Sinai., Stead TS; Warren Alpert Medical School, Brown University., Tran DL; From the Hansjörg Wyss Department of Plastic Surgery, New York University Grossman School of Medicine., Chiu ES; From the Hansjörg Wyss Department of Plastic Surgery, New York University Grossman School of Medicine.
Jazyk:	angličtina
Zdroj:	Plastic and reconstructive surgery [Plast Reconstr Surg] 2024 Oct 01; Vol. 154 (4), pp. 880-889. Date of Electronic Publication: 2023 Nov 03.
DOI:	10.1097/PRS.0000000000011179
Abstrakt:	Background: 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. Methods: 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. Results: 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. Conclusions: 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. (Copyright © 2023 by the American Society of Plastic Surgeons.)
Databáze:	MEDLINE
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