Ratio of Resected Tissue Mass to Pre-Operative Weight Loss as a Predictor for Post-Operative Complications in Abdominal Contouring Procedures after Massive Weight Loss

John Slate-Romano, MD; Navya Baranwal, BA; Damon McIntire, MD; Nikhil Sobti, MD; Raman Mehrzad MD, MHL, MBA; Thor S. Stead, ScB; Paul Liu, MD; Rachel Sullivan, MD

Department of Plastic Surgery, Rhode Island Hospital, Warren Alpert Medical School at  Brown University, Providence, Rhode Island 02903

Background

Results

Results Continued

The global obesity epidemic and growing frequency of bariatric surgeries have heightened the demand for addressing the consequent issue of excess overhanging abdominal pannus through abdominal contouring surgeries. Although these procedures lead to improved mobility, reduced pain, and enhanced quality of life, they also carry a post-operative complication rate of up to 40-50%.

• Post-operative complications were experienced by 176 (49.2%) patients. 

• The average ratio of resected pannus mass to pre-operative weight loss was 5.06 ± 2.71. 

• Individual complications: The ratio of resected pannus weight to pre-operative weight loss was associated with increased rates of seroma (odds ratio, 1.12; P = 0.04) and infection (odds ratio, 1.17; P < 0.01).

• Complications by Clavien Dindo Classification: The ratio of resected pannus weight to pre-operative weight loss was associated with an increased rate of Clavien-Dindo category 2-4 complications (odds ratio, 1.09; P = 0.03). 

• Multivariable logistic regression: After controlling for age, tobacco use, rectus plication, diabetes, and combined surgery, the ratio of resected pannus mass to pre-operative weight loss remained significantly associated with increased rates of Clavien Dindo category 2-4 complications (odds ratio, 1.10; P = 0.03).

Objective

To explore the relationship between the ratio of resected tissue mass to pre-operative weight loss (a surrogate for predicted pannus volume) and complication rates in patients undergoing abdominal contouring procedures following massive weight loss.

Study Design

• Retrospective analysis of patients undergoing abdominal contouring procedures (abdominoplasty or panniculectomy) following massive weight loss.

• Study Period: April 2015 – February 2023

• Data Source: Electronic Medical Records

• Independent Variable: Ratio of resected tissue mass to pre-operative weight loss

• Outcome: Post-Operative Wound Complications

• Complications categorized by Clavien Dindo System (Grades 1-4), taking complication severity, and requirement for interventions, reoperations, and readmissions into consideration

• Hematoma, Seroma, Infection, Dehiscence, Delayed Wound Healing

• Statistics: Univariate andMultivariate logistical regression model to assess association between the ratio of resected tissue mass to pre-operative weight loss and complication rates

• Adjusted for age, tobacco use, rectus plication, diabetes, and combined surgery

Conclusions

Higher ratio of resected pannus mass to pre-operative weight loss is associated with increased complications rates in abdominal contouring surgery in massive weight loss patients. This novel predictor may enhance the surgeon’s ability to modify post-operative management to prevent such complications.