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

• Published in: Plastic and reconstructive surgery (1963) Vol. 142; no. 4; pp. 462e - 471e
• Main Authors: Kantar, Rami S., Rifkin, William J., Wilson, Stelios C., David, Joshua A., Diaz-Siso, J. Rodrigo, Levine, Jamie P., Golas, Alyssa R., Ceradini, Daniel J.
• Format: Journal Article
• Language: English
• Published: United States by the American Society of Plastic Surgeons 01-10-2018; American Society of Plastic Surgeons
• Subjects: Abdominoplasty - adverse effects; Adult; Aged; Comorbidity; Diabetes Mellitus; Female; Humans; Male; Middle Aged; Obesity - complications; Postoperative Complications - etiology; Risk Factors; Smoking - adverse effects; Surgical Wound Infection - etiology; Wound Healing - physiology
• ISSN: 0032-1052; 1529-4242
• DOI: 10.1097/PRS.0000000000004732

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.