title: Safety of Aesthetic Surgery in the Overweight Patient: Analysis of 127,961 Patients.
abstract: BACKGROUND
  Nearly 70% of US adults are overweight or obese (body mass index, BMI ≥ 25 kg/m(2)), and more such patients are seeking aesthetic surgery. Previous studies have evaluated surgical risk in obese (BMI ≥ 30) or morbidly obese (BMI ≥ 40) patients, with mixed results.
  
  
  OBJECTIVE
  This study evaluates BMI 25 to 29.9 and BMI ≥ 30 as independent risk factors of major complications following aesthetic surgery in a large, prospective, multi-center database.
  
  
  METHODS
  A prospective cohort of patients undergoing aesthetic surgery between 2008 and 2013 was identified from the CosmetAssure database (Birmingham, AL). BMI was evaluated as a risk factor for major complications, defined as complications requiring an emergency room visit, hospital admission, or reoperation within 30 days of the procedure. Multivariate analysis controlled for variables including age, gender, smoking, diabetes, combined procedures, and type of surgical facility.
  
  
  RESULTS
  Of the 127,961 patients, 36.2% had BMI ≥ 25. Overweight patients were more likely to be male (12.5%), diabetic (3.3%), nonsmokers (92.8%), or have multiple procedures (41%). Complication rate steadily increased with BMI: 1.4% (BMI < 18.5); 1.6% (18.5-24.9); 2.3% (25-29.9); 3.1% (30-39.9); 4.2% (≥40). Infection (0.8%), venous thromboembolism (VTE, 0.4%), and pulmonary dysfunction (0.2%) were twice as common among overweight patients. Incidence of hematoma was similar in the two groups (0.9%). Complications following abdominoplasty (3.5%), liposuction (0.9%), lower body lift (8.8%), or combined breast and body procedures (4.2%) were significantly higher in overweight patients. On multivariate analysis, being overweight (BMI 25-29.9) or obese (BMI ≥ 30) were independent predictors of any complication (Relative Risk, RR 1.17 and 1.51), especially infection (RR 1.63 and 2.73), and VTE (RR 1.67 and 2.56).
  
  
  CONCLUSIONS
  Overweight (BMI 25-29.9) and obesity (BMI ≥ 30) are both independent risk factors for post-operative infection and VTE in aesthetic surgery. LEVEL OF EVIDENCE 2: Risk.
authors.affiliation: Drs Gupta and Higdon are Assistant Professors, Dr Winocour is a Fellow, Dr Bamba is a Research Fellow, and Dr Shack is a Professor and Chairman, Department of Plastic Surgery, Vanderbilt University, Nashville, TN. Dr Rodriguez-Feo is a Resident, Department of Plastic Surgery, University of Washington, Seattle, WA. Dr Grotting is a Clinical Professor, Division of Plastic Surgery, University of Alabama at Birmingham, Birmingham, AL; and CME/MOC Section Editor for Aesthetic Surgery Journal.
authors.forename: Varun
authors.initials: V
authors.lastname: Gupta
authors.affiliation: Drs Gupta and Higdon are Assistant Professors, Dr Winocour is a Fellow, Dr Bamba is a Research Fellow, and Dr Shack is a Professor and Chairman, Department of Plastic Surgery, Vanderbilt University, Nashville, TN. Dr Rodriguez-Feo is a Resident, Department of Plastic Surgery, University of Washington, Seattle, WA. Dr Grotting is a Clinical Professor, Division of Plastic Surgery, University of Alabama at Birmingham, Birmingham, AL; and CME/MOC Section Editor for Aesthetic Surgery Journal.
authors.forename: Julian
authors.initials: J
authors.lastname: Winocour
authors.affiliation: Drs Gupta and Higdon are Assistant Professors, Dr Winocour is a Fellow, Dr Bamba is a Research Fellow, and Dr Shack is a Professor and Chairman, Department of Plastic Surgery, Vanderbilt University, Nashville, TN. Dr Rodriguez-Feo is a Resident, Department of Plastic Surgery, University of Washington, Seattle, WA. Dr Grotting is a Clinical Professor, Division of Plastic Surgery, University of Alabama at Birmingham, Birmingham, AL; and CME/MOC Section Editor for Aesthetic Surgery Journal.
authors.forename: Charles
authors.initials: C
authors.lastname: Rodriguez-Feo
authors.affiliation: Drs Gupta and Higdon are Assistant Professors, Dr Winocour is a Fellow, Dr Bamba is a Research Fellow, and Dr Shack is a Professor and Chairman, Department of Plastic Surgery, Vanderbilt University, Nashville, TN. Dr Rodriguez-Feo is a Resident, Department of Plastic Surgery, University of Washington, Seattle, WA. Dr Grotting is a Clinical Professor, Division of Plastic Surgery, University of Alabama at Birmingham, Birmingham, AL; and CME/MOC Section Editor for Aesthetic Surgery Journal.
authors.forename: Ravinder
authors.initials: R
authors.lastname: Bamba
authors.affiliation: Drs Gupta and Higdon are Assistant Professors, Dr Winocour is a Fellow, Dr Bamba is a Research Fellow, and Dr Shack is a Professor and Chairman, Department of Plastic Surgery, Vanderbilt University, Nashville, TN. Dr Rodriguez-Feo is a Resident, Department of Plastic Surgery, University of Washington, Seattle, WA. Dr Grotting is a Clinical Professor, Division of Plastic Surgery, University of Alabama at Birmingham, Birmingham, AL; and CME/MOC Section Editor for Aesthetic Surgery Journal.
authors.forename: R Bruce
authors.initials: RB
authors.lastname: Shack
authors.affiliation: Drs Gupta and Higdon are Assistant Professors, Dr Winocour is a Fellow, Dr Bamba is a Research Fellow, and Dr Shack is a Professor and Chairman, Department of Plastic Surgery, Vanderbilt University, Nashville, TN. Dr Rodriguez-Feo is a Resident, Department of Plastic Surgery, University of Washington, Seattle, WA. Dr Grotting is a Clinical Professor, Division of Plastic Surgery, University of Alabama at Birmingham, Birmingham, AL; and CME/MOC Section Editor for Aesthetic Surgery Journal.
authors.forename: James C
authors.initials: JC
authors.lastname: Grotting
authors.affiliation: Drs Gupta and Higdon are Assistant Professors, Dr Winocour is a Fellow, Dr Bamba is a Research Fellow, and Dr Shack is a Professor and Chairman, Department of Plastic Surgery, Vanderbilt University, Nashville, TN. Dr Rodriguez-Feo is a Resident, Department of Plastic Surgery, University of Washington, Seattle, WA. Dr Grotting is a Clinical Professor, Division of Plastic Surgery, University of Alabama at Birmingham, Birmingham, AL; and CME/MOC Section Editor for Aesthetic Surgery Journal.
authors.forename: K Kye
authors.initials: KK
authors.lastname: Higdon
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009765:Obesity / Q000150:complications*; D050177:Overweight / Q000150:complications*; D011183:Postoperative Complications / Q000453:epidemiology*; D011446:Prospective Studies; D019651:Plastic Surgery Procedures / Q000009:adverse effects / Q000379:methods*; D012086:Reoperation; D012307:Risk Factors; D055815:Young Adult