Safety of Aesthetic Surgery in the Overweight Patient: Analysis of 127,961 Patients
Safety of Aesthetic Surgery in the Overweight Patient: Analysis of 127,961 Patients
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DOI：
10.1093/asj/sjv268
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发表时间：
2016-06-01
影响因子：
2.9
通讯作者：
Higdon, K. Kye
中科院分区：
文献类型：
--
作者：
Gupta, Varun;Winocour, Julian;Higdon, K. Kye
近70%的美国成年人超重或肥胖（体重指数，BMI每千分之一日元25公斤/米(2)），越来越多的这样的患者正在寻求美容手术。先前的研究评估了肥胖（BMI为千分之一30）或病态肥胖（BMI为千分之一40）患者的手术风险，结果好坏参半。本研究在一个大型的、前瞻性的、多中心的数据库中评估BMI 25 - 29.9和BMI千分之一30作为美容手术后主要并发症的独立危险因素。从CosmetAssure数据库（Birmingham， AL）中确定了2008年至2013年间接受美容手术的患者的前瞻性队列。BMI被评估为主要并发症的危险因素，主要并发症定义为需要急诊室就诊、住院或手术后30天内再次手术的并发症。多变量分析控制了包括年龄、性别、吸烟、糖尿病、联合手术和手术设备类型在内的变量。在127961名患者中，36.2%的患者BMI指数为0.25%。超重患者多为男性（12.5%）、糖尿病患者（3.3%）、非吸烟者（92.8%）或多次手术（41%）。随着BMI的增加，并发症发生率稳步上升：1.4% (BMI < 18.5)；1.6% (18.5 - -24.9);2.3% (25 - 29.9);3.1% (30 - 39.9);4.2%（千分之一日元）。感染（0.8%）、静脉血栓栓塞（VTE, 0.4%）和肺功能障碍（0.2%）是超重患者的两倍。两组血肿发生率相似（0.9%）。在超重患者中，腹部成形术（3.5%）、吸脂（0.9%）、下半身提升（8.8%）或乳房和身体联合手术（4.2%）后的并发症明显更高。在多变量分析中，超重（BMI 25-29.9）或肥胖（BMI千分之一30）是任何并发症的独立预测因素（相对风险，RR 1.17和1.51），尤其是感染（RR 1.63和2.73）和静脉血栓栓塞（RR 1.67和2.56）。超重（BMI 25-29.9）和肥胖（BMI千分之一30）都是美容手术术后感染和静脉血栓栓塞的独立危险因素。
Nearly 70% of US adults are overweight or obese (body mass index, BMI a parts per thousand yen 25 kg/m(2)), and more such patients are seeking aesthetic surgery. Previous studies have evaluated surgical risk in obese (BMI a parts per thousand yen 30) or morbidly obese (BMI a parts per thousand yen 40) patients, with mixed results.This study evaluates BMI 25 to 29.9 and BMI a parts per thousand yen 30 as independent risk factors of major complications following aesthetic surgery in a large, prospective, multi-center database.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.Of the 127,961 patients, 36.2% had BMI a parts per thousand yen 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% (a parts per thousand yen40). 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 a parts per thousand yen 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).Overweight (BMI 25-29.9) and obesity (BMI a parts per thousand yen 30) are both independent risk factors for post-operative infection and VTE in aesthetic surgery.