title: Multiple procedures and staging in the massive weight loss population.
abstract: BACKGROUND
  Unlike traditional plastic surgery patients who present with a specific anatomical complaint, massive weight loss patients often have multiple regions of concern. No single procedure can address the whole-body deformities associated with massive weight loss. The authors sought to quantify their clinical experience to provide evidence-based analysis of procedural combination in body contouring.
  
  
  METHODS
  Patients were enrolled in an institutional review board-approved prospective clinical database over a 5-year period. Procedure categories included breast, medial thigh lift, buttock and lateral thigh lift, upper back lift, brachioplasty, and abdomen. Analysis of variance was used to analyze differences between procedure combinations.
  
  
  RESULTS
  Six hundred nine massive weight loss patients underwent 661 cases involving 1070 procedures. Length of hospital stay increased with the number of procedures performed (p < 0.001). Second-stage cases (n = 60) had similar complication rates and length of hospital stay. Seroma and dehiscence were strongly correlated with the number of procedures (p < 0.001), as were tissue necrosis and infection (p = 0.02), whereas hematoma was unrelated (p = 0.25). Major complications did not increase in multiple-procedure cases.
  
  
  CONCLUSIONS
  In a large experience at a high-volume center, concomitant procedures were performed safely in carefully selected patients with low major complication rates. Although aggregate minor complication rates were predictably higher than in single-procedure cases, there was no significant increase on a per-procedure basis. Multiple procedures can be combined safely in the body contouring patient, with surgical staging offering a viable alternative for patients who are unable to undergo combined procedures.
authors.affiliation: Pittsburgh, Pa. From the Department of Surgery, Division of Plastic and Reconstructive Surgery, University of Pittsburgh Medical Center.
authors.forename: Devin
authors.initials: D
authors.lastname: Coon
authors.forename: Joseph
authors.initials: J
authors.lastname: Michaels
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Gusenoff
authors.forename: Chad
authors.initials: C
authors.lastname: Purnell
authors.forename: Tali
authors.initials: T
authors.lastname: Friedman
authors.forename: J Peter
authors.initials: JP
authors.lastname: Rubin
mesh_terms: D000005:Abdomen / Q000601:surgery; D000328:Adult; D001415:Back / Q000601:surgery; D001940:Breast / Q000601:surgery; D002081:Buttocks / Q000601:surgery; D016208:Databases, Factual; D005260:Female; D006406:Hematoma / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery*; D011183:Postoperative Complications / Q000601:surgery*; D012086:Reoperation; D049291:Seroma / Q000601:surgery; D013518:Surgery, Plastic / Q000379:methods*; D013529:Surgical Wound Dehiscence / Q000601:surgery; D013530:Surgical Wound Infection / Q000601:surgery; D013848:Thigh / Q000601:surgery; D015431:Weight Loss