BMI and Revision Surgery for Abdominoplasties: Complication Definitions Revisited Using the Clavien-Dindo Classification

Abstract

After body contouring surgery of the lower trunk (CSLT), the definition, rate (4%-70%), and documentation of complications vary.

Objectives: We analyzed the effect of risk factors on the outcome based on the Clavien-Dindo classification (CDC) after CSLT surgery and polled postoperative satisfaction among patients.

Methods: All patients undergoing CSLT from 2001 to 2016 were included and were classified according to the CDC for postoperative events. Statistical analysis included proportional odds logistic regression analysis. We polled patients to grade their satisfaction with the postoperative result and whether they would have the operation performed again.

Results: A total of 265 patients were included: 60 (22.6%), 25 (9.4%), 28 (10.6%), and 21 (7.9%) were in CDC grades I, II, IIIa, and IIIb, respectively. A high preoperative body mass index significantly increased the odds for a postoperative event requiring revision surgery under general anesthesia (CDC grade IIIb, odds ratio 0.93, 95% confidence interval 0.89-0.97, P = 0.001). One-hundred twenty-eight patients (48.3%) participated in the poll: 101 (78.9%) were either happy or content with the postoperative results, and 117 (91.4%) would have the procedure performed again, including all nine patients with CDC grade IIIb.

Conclusions: Our results confirm that a high body mass index is a statistically significant risk factor for requiring major revision surgery after CSLT. Despite being a complication prone intervention, postoperative satisfaction after CSLT was ranked favorably in our sample. We recommend that the CDC be used in all surgical specialties to evaluate complications and permit future comparability of pooled data.

Fig. 1.

Age, gender, smoking status, surgical technique, and American Society of Anesthesiologists risk classification, physical status classifications system scale (Total = absolute number of available observations/datapoints).

Fig. 2.

Odds ratio of preoperative BMI on the probability of developing events defined by the CDC: The higher the BMI the more likely the odds for developing postoperative events requiring operative take back with (CDC IIIb, yellow curve) or without general anesthesia (CDC IIIa, blue curve). Low-grade postoperative events (CDC 0, black curve) were less likely to occur with increasing BMI. Events graded CDC I (red curve) or CDC II (green curve) were almost unaffected by the BMI.