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Abdominal Panniculectomy: Determining the Impact of Diabetes on Complications and Risk Factors for Adverse Events

Kantar, Rami S. M.D.; Rifkin, William J. B.A.; Wilson, Stelios C. M.D.; David, Joshua A. B.S.; Diaz-Siso, J. Rodrigo M.D.; Levine, Jamie P. M.D.; Golas, Alyssa R. M.D.; Ceradini, Daniel J. M.D.

Plastic and Reconstructive Surgery: October 2018 - Volume 142 - Issue 4 - p 462e-471e
doi: 10.1097/PRS.0000000000004732
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Background: The prevalence of obesity along with bariatric surgery and massive weight loss requiring panniculectomy is increasing in the United States. The effect of diabetes mellitus on outcomes following panniculectomy remains poorly defined despite its prevalence. This study aims to evaluate the impact of diabetes mellitus on complications following panniculectomy and determine risk factors for adverse events.

Methods: The American College of Surgeons National Surgical Quality Improvement Program database was used to identify patients undergoing panniculectomy between 2010 and 2015. Patients were stratified based on diabetes status.

Results: Review of the database identified 7035 eligible patients who underwent panniculectomy, of which 770 (10.9 percent) were diabetic. Multivariate regression showed that diabetes mellitus was a significant risk factor for wound dehiscence (OR, 1.92; 95 percent CI, 1.41 to 3.15; p = 0.02). Obesity was a significant risk factor for superficial (OR, 2.78; 95 percent CI, 1.53 to 3.69; p < 0.001) and deep (OR, 1.52; 95 percent CI, 1.38 to 3.97; p = 0.01) incisional surgical-site infection. Smokers were also at an increased risk for superficial (OR, 1.42; 95 percent CI, 1.19 to 1.75; p = 0.03) and deep (OR, 1.63; 95 percent CI, 1.31 to 2.22; p = 0.02) incisional surgical-site infection.

Conclusions: Diabetes mellitus is an independent risk factor for wound dehiscence following panniculectomy. Obesity and smoking were significant risk factors for superficial and deep incisional surgical-site infection. These results underscore the importance of preoperative risk factor evaluation in patients undergoing panniculectomy for safe outcomes.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, II.

Patient Safety CME.Video Discussion By Al ALY, M.D., is Available Online for this Article.

New York, N.Y.

From the Hansjörg Wyss Department of Plastic Surgery, New York University Langone Medical Center.

Received for publication November 10, 2017; accepted March 16, 2018.

The first two authors contributed equally to this article.

Disclosure:The authors have no financial interest to declare in relation to the content of this article.

By reading this article, you are entitled to claim one (1) hour of Category 2 Patient Safety Credit. ASPS members can claim this credit by logging in to PlasticSurgery.org Dashboard, clicking “Submit CME,” and completing the form.

A Video Discussion by Al Aly, M.D., accompanies this article. Go to PRSJournal.com and click on “Video Discussions” in the “Digital Media” tab to watch.

Daniel J. Ceradini, M.D., Hansjörg Wyss Department of Plastic Surgery, New York University Langone Medical Center, 305 East 33rd Street, New York, N.Y. 10016, daniel.ceradini@nyumc.org

Copyright © 2018 by the American Society of Plastic Surgeons