title: Combining abdominal and cosmetic breast surgery does not increase short-term complication rates: a comparison of each individual procedure and pretreatment risk stratification tool.
abstract: BACKGROUND
  Combined abdominal and breast surgery presents a convenient and relatively cost-effective approach for accomplishing both procedures.
  
  
  OBJECTIVE
  This study is the largest to date assessing the safety of combined procedures, and it aims to develop a simple pretreatment risk stratification method for patients who desire a combined procedure.
  
  
  METHODS
  All women undergoing abdominoplasty, panniculectomy, augmentation mammaplasty, and/or mastopexy in the TOPS database were identified. Demographics and outcomes for combined procedures were compared to individual procedures using χ(2) and Student's t-tests. Multiple logistic regression provided adjusted odds ratios for the effect of a combined procedure on 30-day complications. Among combined procedures, a logistic regression model determined point values for pretreatment risk factors including diabetes (1 point), age over 53 (1), obesity (2), and 3+ ASA status (3), creating a 7-point pretreatment risk stratification tool.
  
  
  RESULTS
  A total of 58,756 cases met inclusion criteria. Complication rates among combined procedures (9.40%) were greater than those of aesthetic breast surgery (2.66%; P < .001) but did not significantly differ from abdominal procedures (9.75%; P = .530). Nearly 77% of combined cases were classified as low-risk (0 points total) with a 9.78% complication rates. Medium-risk patients (1 to 3 points) had a 16.63% complication rate, and high-risk (4 to 7 points) 38.46%.
  
  
  CONCLUSIONS
  Combining abdominal and breast procedures is safe in the majority of patients and does not increase 30-day complications rates. The risk stratification tool can continue to ensure favorable outcomes for patients who may desire a combined surgery.
  
  
  METHODS
  4 Risk.
authors.affiliation: Ms Khavanin and Mr Mlodinow are Medical Students, Dr Jordan is a Resident, Ms Vieira is a Clinical Researcher, and Dr Kim is an Attending Physician, Northwestern University, Feinberg School of Medicine, Chicago, Illinois. Mr Hume is the TOPS Registry Administrator and Mr Simmons is a TOPS Registry Clinical Research Associate, Arlington Heights, Illinois. Dr Murphy is an Attending Physician, Lehigh Valley Health Network, Allentown, Pennsylvania. Dr Gutowski is a plastic surgeon in private practice in Northbrook, Illinois.
authors.forename: Nima
authors.initials: N
authors.lastname: Khavanin
authors.affiliation: Ms Khavanin and Mr Mlodinow are Medical Students, Dr Jordan is a Resident, Ms Vieira is a Clinical Researcher, and Dr Kim is an Attending Physician, Northwestern University, Feinberg School of Medicine, Chicago, Illinois. Mr Hume is the TOPS Registry Administrator and Mr Simmons is a TOPS Registry Clinical Research Associate, Arlington Heights, Illinois. Dr Murphy is an Attending Physician, Lehigh Valley Health Network, Allentown, Pennsylvania. Dr Gutowski is a plastic surgeon in private practice in Northbrook, Illinois.
authors.forename: Sumanas W
authors.initials: SW
authors.lastname: Jordan
authors.affiliation: Ms Khavanin and Mr Mlodinow are Medical Students, Dr Jordan is a Resident, Ms Vieira is a Clinical Researcher, and Dr Kim is an Attending Physician, Northwestern University, Feinberg School of Medicine, Chicago, Illinois. Mr Hume is the TOPS Registry Administrator and Mr Simmons is a TOPS Registry Clinical Research Associate, Arlington Heights, Illinois. Dr Murphy is an Attending Physician, Lehigh Valley Health Network, Allentown, Pennsylvania. Dr Gutowski is a plastic surgeon in private practice in Northbrook, Illinois.
authors.forename: Brittany L
authors.initials: BL
authors.lastname: Vieira
authors.affiliation: Ms Khavanin and Mr Mlodinow are Medical Students, Dr Jordan is a Resident, Ms Vieira is a Clinical Researcher, and Dr Kim is an Attending Physician, Northwestern University, Feinberg School of Medicine, Chicago, Illinois. Mr Hume is the TOPS Registry Administrator and Mr Simmons is a TOPS Registry Clinical Research Associate, Arlington Heights, Illinois. Dr Murphy is an Attending Physician, Lehigh Valley Health Network, Allentown, Pennsylvania. Dr Gutowski is a plastic surgeon in private practice in Northbrook, Illinois.
authors.forename: Keith M
authors.initials: KM
authors.lastname: Hume
authors.affiliation: Ms Khavanin and Mr Mlodinow are Medical Students, Dr Jordan is a Resident, Ms Vieira is a Clinical Researcher, and Dr Kim is an Attending Physician, Northwestern University, Feinberg School of Medicine, Chicago, Illinois. Mr Hume is the TOPS Registry Administrator and Mr Simmons is a TOPS Registry Clinical Research Associate, Arlington Heights, Illinois. Dr Murphy is an Attending Physician, Lehigh Valley Health Network, Allentown, Pennsylvania. Dr Gutowski is a plastic surgeon in private practice in Northbrook, Illinois.
authors.forename: Alexei S
authors.initials: AS
authors.lastname: Mlodinow
authors.affiliation: Ms Khavanin and Mr Mlodinow are Medical Students, Dr Jordan is a Resident, Ms Vieira is a Clinical Researcher, and Dr Kim is an Attending Physician, Northwestern University, Feinberg School of Medicine, Chicago, Illinois. Mr Hume is the TOPS Registry Administrator and Mr Simmons is a TOPS Registry Clinical Research Associate, Arlington Heights, Illinois. Dr Murphy is an Attending Physician, Lehigh Valley Health Network, Allentown, Pennsylvania. Dr Gutowski is a plastic surgeon in private practice in Northbrook, Illinois.
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Simmons
authors.affiliation: Ms Khavanin and Mr Mlodinow are Medical Students, Dr Jordan is a Resident, Ms Vieira is a Clinical Researcher, and Dr Kim is an Attending Physician, Northwestern University, Feinberg School of Medicine, Chicago, Illinois. Mr Hume is the TOPS Registry Administrator and Mr Simmons is a TOPS Registry Clinical Research Associate, Arlington Heights, Illinois. Dr Murphy is an Attending Physician, Lehigh Valley Health Network, Allentown, Pennsylvania. Dr Gutowski is a plastic surgeon in private practice in Northbrook, Illinois.
authors.forename: Robert X
authors.initials: RX
authors.lastname: Murphy
authors.affiliation: Ms Khavanin and Mr Mlodinow are Medical Students, Dr Jordan is a Resident, Ms Vieira is a Clinical Researcher, and Dr Kim is an Attending Physician, Northwestern University, Feinberg School of Medicine, Chicago, Illinois. Mr Hume is the TOPS Registry Administrator and Mr Simmons is a TOPS Registry Clinical Research Associate, Arlington Heights, Illinois. Dr Murphy is an Attending Physician, Lehigh Valley Health Network, Allentown, Pennsylvania. Dr Gutowski is a plastic surgeon in private practice in Northbrook, Illinois.
authors.forename: Karol A
authors.initials: KA
authors.lastname: Gutowski
authors.affiliation: Ms Khavanin and Mr Mlodinow are Medical Students, Dr Jordan is a Resident, Ms Vieira is a Clinical Researcher, and Dr Kim is an Attending Physician, Northwestern University, Feinberg School of Medicine, Chicago, Illinois. Mr Hume is the TOPS Registry Administrator and Mr Simmons is a TOPS Registry Clinical Research Associate, Arlington Heights, Illinois. Dr Murphy is an Attending Physician, Lehigh Valley Health Network, Allentown, Pennsylvania. Dr Gutowski is a plastic surgeon in private practice in Northbrook, Illinois.
authors.forename: John Y S
authors.initials: JY
authors.lastname: Kim
mesh_terms: D061645:Abdominoplasty / Q000009:adverse effects / Q000379:methods*; D000328:Adult; D017677:Age Distribution; D015331:Cohort Studies; D003131:Combined Modality Therapy; D004954:Esthetics; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D016462:Mammaplasty / Q000009:adverse effects / Q000379:methods*; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011183:Postoperative Complications / Q000453:epidemiology* / Q000503:physiopathology*; D064266:Preexisting Condition Coverage; D011300:Preoperative Care / Q000379:methods; D012016:Reference Values; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D013997:Time Factors; D016896:Treatment Outcome