title: Body mass and surgical complications in the postbariatric reconstructive patient: analysis of 511 cases.
abstract: OBJECTIVE
  To analyze the impact of body mass indices on postbariatric reconstructive surgery complications.
  
  
  BACKGROUND
  An increasing number of patients are presenting after massive weight loss due to bariatric surgery or diet and exercise. Many of these patients have residual obesity, which may compromise outcomes.
  
  
  METHODS
  449 patients were enrolled in a prospective registry over 6 years. Measures included medical complications and comorbidities. All cases were analyzed together as well as in two subgroups: single procedure cases (Group I) and multiple procedure cases (Group II).
  
  
  RESULTS
  449 patients (407 female, 42 male) with a mean age of 44.5 +/- 10.3 underwent 511 separate operations. Mean pre-weight loss BMI (Max BMI) was 51.6 +/- 9.5 kg/m2, post-weigh loss BMI (Current BMI) was 29.3 +/- 5.0 and the DeltaBMI was 22.3 +/- 7.5. For all cases (n = 511), the presence of a surgical complication was directly related to Max BMI (P = 0.002) and DeltaBMI (P = 0.002) but not Current BMI.Group I consisted of 194 single procedure cases. Complications in Group I were related to Max BMI (P = 0.006) and Current BMI (P = 0.02) but not DeltaBMI. Max BMI impacted infections (P = 0.003) while Current BMI impacted dehiscence (P = 0.009) and infections (P = 0.03). Group II consisted of 317 cases with only DeltaBMI directly related to overall complications (P = 0.01).
  
  
  CONCLUSIONS
  Body mass indices influence complications in postbariatric reconstructive surgery. Current BMI may impact complications in single-procedure cases, but appears to play less of a role in larger cases. Careful patient selection, assessment of surgical complexity, and recognition of the particular risks increased by residual obesity can help to optimize outcomes in this patient population.
authors.affiliation: Department of Surgery, Division of Plastic and Reconstructive Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania 15261, USA.
authors.forename: Devin
authors.initials: D
authors.lastname: Coon
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Gusenoff
authors.forename: Neeta
authors.initials: N
authors.lastname: Kannan
authors.forename: Samar R
authors.initials: SR
authors.lastname: El Khoudary
authors.forename: Nima
authors.initials: N
authors.lastname: Naghshineh
authors.forename: J Peter
authors.initials: JP
authors.lastname: Rubin
mesh_terms: D000328:Adult; D050110:Bariatric Surgery; D015992:Body Mass Index; D062109:Dermatologic Surgical Procedures; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology; D019651:Plastic Surgery Procedures / Q000009:adverse effects*; D050151:Subcutaneous Fat / Q000601:surgery; D015431:Weight Loss