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Effect of Posthospital Syndrome on Health Care Utilization After Abdominal Contouring Surgery

Swiatek, Peter R., BA*; Johnson, Shepard P., MBBS; Wang, Lu, PhD; Liu, Mochuan, MS§; Chung, Ting-Ting, MS; Chung, Kevin C., MD, MS

doi: 10.1097/SAP.0000000000001613

Background Posthospital syndrome (PHS) is a transient condition after acute hospitalizations when patients are physiologically deconditioned. The objective of this study was to determine if having PHS at the time of abdominal contouring surgery increased the incidence of postoperative adverse medical events.

Methods We conducted a retrospective cohort study of patients enrolled in the MarketScan Databases who underwent outpatient functional or cosmetic abdominal contouring surgery (ie, abdominoplasty, liposuction, or panniculectomy) from April 2010 to August 2015. Patients were separated into 2 groups based upon PHS exposure, defined by hospitalization within 90 days before surgery. Differential health care utilization within 30 days after surgery was compared between cohorts.

Results Among the 18,947 patients included in the final cohort, 1045 patients (6%) had PHS at the time of abdominal contouring surgery. Patients with PHS experienced more emergency department visits (0.16 vs 0.08 visits; adjusted odds ratio, 1.60; P < 0.001) and more episodes of hospitalization (0.11 vs 0.04 episodes; adjusted odds ratio, 1.70; P < 0.001) within 30 days postoperatively. The mean unadjusted health care utilization after abdominal contouring surgery for patients with PHS was US $7888 (SD, 17,659) versus US $2943 (SD, 9096) in patients without PHS. After controlling for confounders, such as comorbidity burden, PHS was associated with US $3944 greater cost than patients without PHS (P < 0.001).

Conclusions Among patients undergoing outpatient abdominal contouring surgery, having PHS increased the incidence of adverse medical events requiring medical attention in the 30-day postoperative period. These findings support the inclusion of PHS in preoperative evaluation and preparation for patients seeking abdominal contouring surgery.

From the *University of Michigan Medical School, Ann Arbor, MI;

Department of Plastic Surgery, Vanderbilt University, Nashville, TN;

Department of Biostatistics, University of Michigan;

§Department of Statistics, University of Michigan, Ann Arbor, MI;

Center for Big Data Analytics and Statistics, Chang Gung Memorial Hospital, Taoyuan, Taiwan; and

Section of Plastic Surgery, Department of Surgery, University of Michigan Medical School, Ann Arbor, MI.

Received May 3, 2018, and accepted for publication, after revision July 12, 2018.

Conflicts of interest and sources of funding: K.C.C. is currently receiving the Midcareer Investigator Award in Patient-Oriented Research (2 K24-AR053120-06) from the National Institutes of Health. This work was also funded by the Chang Gung Memorial Hospital project CORPG3G0111 and CORPG3G0161. None of the authors has a financial interest in any of the products, devices, or drugs mentioned in this article.

Reprints: Kevin C. Chung, MD, MS, Section of Plastic Surgery, Department of Surgery, University of Michigan, 2130 Taubman Center, 1500 E Medical Center Dr, Ann Arbor, MI 48109-0340. E-mail:

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