title: Post-bariatric panniculectomy: pre-panniculectomy body mass index impacts the complication profile.
abstract: BACKGROUND
  Morbid obesity continues to increase in the United States, which accounts for the increase in bariatric procedures performed. After these patients experience massive weight loss, many are left with a redundant pannus that poses physical limitations and psychosocial disturbances. An increasing proportion of bariatric patients are returning for body-contouring procedures.
  
  
  METHODS
  This is a retrospective cohort study set in a tertiary care center. We evaluated 126 post-bariatric panniculectomies performed over a 3-year period. Perioperative and postoperative data were collected through chart review. Descriptive and inferential analyses were performed using SPSS 11.0.
  
  
  RESULTS
  Ninety-six percent of patients were female. Mean age of the population was 42 (+/-12). The average post-bariatric weight loss and pre-panniculectomy weight were 53 (+/-16) kg and 78 (+/-14) kg, respectively. Complication rates were as follows: seroma 17%, hematoma 13%, surgical site infection (SSI) 17%, transfusion 6%, skin breakdown/necrosis 11%, and re-exploration 11%. Forty percent of patients experienced a complication. Using multivariate logistic regression, we evaluated age, pre-panniculectomy body mass index (BMI), American Society of Anesthesiologists (ASA) class, specimen weight, and operative duration; only pre-panniculectomy BMI was an independent predictor for developing a postoperative complication (odds ratio 3.3, confidence interval 1.2 to 8.4, P < .01).
  
  
  CONCLUSIONS
  Post-bariatric patients who have sustained significant weight loss report subjective improvement after panniculectomy. Even though this population has experienced significant weight loss, they are still at an increased risk for postoperative complications. Maximal reduction in BMI should be stressed to these patients in order to reduce their risk of complications following panniculectomy.
authors: Department of Surgery, Madigan Army Medical Center, 9040A Reid St., Tacoma, WA 98431, USA. Zachary.arthurs@us.army.mil
authors: Zachary M
authors: ZM
authors: Arthurs
authors: Daniel
authors: D
authors: Cuadrado
authors: Vance
authors: V
authors: Sohn
authors: Katharine
authors: K
authors: Wolcott
authors: Kelley
authors: K
authors: Lesperance
authors: Preston
authors: P
authors: Carter
authors: James
authors: J
authors: Sebesta
mesh_terms: D000328:Adult; D050110:Bariatric Surgery; D015992:Body Mass Index; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D009767:Obesity, Morbid / Q000601:surgery*; D011182:Postoperative Care; D011183:Postoperative Complications / Q000453:epidemiology; D019651:Plastic Surgery Procedures / Q000009:adverse effects* / Q000379:methods; D012189:Retrospective Studies; D050507:Subcutaneous Fat, Abdominal / Q000601:surgery*