Safety of Aesthetic Surgery in the Overweight Patient: Analysis of 127,961 Patients
Varun Gupta MD, MPH; Julian Winocour MD; Charles Rodriguez-Feo BS; R Bruce Shack MD, FACS; James C Grotting MD, FACS; Kent Higdon MD, FACS
- Nearly 1.9 million surgical aesthetic procedures performed in 2013 at a cost of 7 billion dollars.
- Aesthetic Surgery is becoming more popular with 6.5% increase from 2012 to 2013.
- Major complications are rare but can cause prolonged morbidity and significant financial burden.
- About 69% of U.S. adults are overweight or obese (Body Mass Index, BMI≥25).
- BMI≥25 is most prevalent among middle age adults (73%), the group which receives 39.3% of all cosmetic procedures.
- Previous studies have evaluated surgical risk in obese (BMI≥30) or morbidly obese (BMI≥40) patients, with mixed results.
- Define the prevalence of BMI≥25 in patients undergoing aesthetic surgery procedures in a large, prospective, multicenter database.
- Compare incidence and type of complications between patients with BMI≥25 and those with BMI<25, undergoing various aesthetic surgical procedures.
- Identify specific procedures where BMI≥25 significantly increases risk of complications.
- Study BMI≥25 as an independent risk factor for major complications following aesthetic surgery.
- Patients prospectively enrolled in CosmetAssureTM* program for aesthetic procedures between 2008 and 2013.
- Major complications (Requiring ER visit, hospital admission or reoperation) within 30 days of the operation recorded.
- BMI, age, gender, smoking, diabetes, combined procedures and type of facility evaluated as risk factors.
- Descriptive statistics, chi square (univariate) and multivariate logistic regression analyses performed with SPSS v17 (SPSS Inc., Chicago, IL).
*CosmetAssure™, a private insurance provider, covers treatment of significant complications after cosmetic surgery. It is available only to ABPS board certified/eligible plastic surgeons. All patients undergoing procedures at participating practices are required to enroll in the program. Surgeon-reported significant complication, filed as a claim, is captured in the database.
- 183,913 cosmetic surgical procedures were performed on 129,007 patients between May 2008 and 2013. BMI information was available on 127,691 patients. 36.2% (46,325) were overweight or obese with BMI≥25. Major complications occurred in 2,506 (1.9%) patients.
- Prevalence of BMI≥25 is much lower in cosmetic surgery patients (36.2%) compared to general population.
- BMI ≥ 25 is an independent risk factor for major post-operative complications (RR1.3), especially infection (RR 2.0) and VTE (RR 2.0) in aesthetic surgery.
- Risk of hematoma (0.9%) is not increased with BMI ≥ 25.
- Increase in complication risk was most significant in abdominoplasty (3.5%), liposuction (0.9%), lower body lift (8.8%) or combined breast and body procedures (4.2%).
- Large, prospectively collected, national, multicenter database.
- Isolates major complications which lead to prolonged morbidity, additional cost to the patient and the surgeon.
- Large database allows us to look at specific procedure combinations to assess risk.
- Patients are enrolled irrespective of their pre-operative risk. Thus, observed incidence rates likely reflect true rates in the community.
- Patient population very similar to that reported by ASAPS, confirming validity of the data.
- Previous reports have cross-validated CosmetAssure and TOPS databases.
- Controlled for minimum surgeon qualifications with only board certified/eligible plastic surgeons eligible to participate.
- Unable to assess minor, but clinically significant, complications (seroma, minor infection, dehiscense etc.).
- Only looked at complications occurring within 30 days of the operation.
- Unknown final outcome after management of the complications.
- Only includes surgeons that sign up for CosmetAssure (does not include all ABPS Plastic Surgeons)
- Not all comorbidities captured in the database (CAD, Hypertension, antiplatelet/anticoagulant use etc.).
- Data not available on factors such as ASA class, prophylactic antibiotics, DVT prophylaxis, duration of surgery, type of anesthesia etc.
BMI ≥ 25 is an independent risk factor for major post-operative complications (RR1.3), especially infection (RR 2.0) and VTE (RR 2.0) in aesthetic surgery.