Year: 2022
Type: review
Abstract: We read Bigarella et al’s study in which they investigated a number of excellent articles on the impact of obesity on the postoperative complications of plastic surgeries.1 As the prevalence of obesity increases, physicians are expressing growing interest in its role in the pathophysiology of diseases and the efficacy of therapies. Although there have been previous studies on the impact of obesity in breast reconstruction,2 this research represents the first meta-analysis and systematic review of the influences of obesity on postoperative complications in plastic surgeries in general, including both cosmetic and reconstructive surgeries. Despite the important demonstration of an increased risk ratio (RR) with obese patients undergoing breast reconstructions, it caught our attention that other reconstructive surgeries, including head and neck, lower extremity, and abdominal reconstructions, demonstrated nonsignificant differences between the obese and normal-weight control groups (Figure 4 in the original study), However, data in the meta-analysis indicate a significant difference between the obese and nonobese population in the abdomen subgroup (RR, 1.53; 95% CI, 1.32-1.77). Furthermore, we noticed that the study by Maricevich et al reported reconstruction of the posterior abdominal wall following sacrectomy by rectus abdominis myocutaneous (68.5%), gluteal (27.8%), and combined gluteal/rectus abdominis myocutaneous (3.7%) flap reconstructions. In other words, the study could be placed into the abdomen subgroup although the original meta-analysis categorized it into the sacretomy defect subgroup. Therefore, an updated analysis was performed for reconstructions other than those of breasts, with each region separated into different subgroups. The updated analysis was based on a random-effects model, and sequential analysis might be warranted for the significant finding. All analyses were carried out with R. Overall and subgroup analysis for RR of obese vs normal-weight patients undergoing reconstructions other than those of breasts is shown in Figure 1A. There were 1490 lower-extremity reconstructions, 3064 head-and-neck reconstructions, 2255 abdominal reconstructions, and 838 nonspecific sites of reconstructions. Overall complication rates demonstrated nonsignificant risk between obese and nonobese patients, which was consistent with the original study. However, the result for the abdomen subgroup showed that the risk of overall complication in obesity was significantly higher than in the nonobese population (RR, 1.53; 95% CI, 1.33-1.77; P < .001). The increased risk for obese patients undergoing abdominal reconstructive surgeries is similar to the finding in the original meta-analysis (RR, 1.53; 95% CI, 1.32-1.77; P < .00001).1 (A) Any complications in obese vs nonobese patients in other reconstructions. (B) Sequential analysis with monitoring boundaries on rates of any complications in patients undergoing all other reconstructive surgeries. (C) Sequential analysis with monitoring boundaries on rates of any complications in patients undergoing abdominal reconstructions. With regard to the results of sequential analysis, the z-score curve for other reconstructive surgeries did not cross the boundaries, demonstrating that it did not reach the required information size (required sample size, 496,219; acquired sample size, 148,866) and thus was not sufficient to conclude any association between obesity and risk for all other reconstructions (Figure 1B). However, in sequential analysis of abdominal reconstructions (Figure 1C), the z-score curve crossed the required information size (required sample size, 4567; acquired sample size, 2255), indicating conclusive evidence that the obese patient could have a greater risk when undergoing abdominal reconstructions in addition to breast reconstructions. The results in this letter respond to a recent recommendation that rated extreme obesity as a relative contraindication to abdominal reconstruction.3 The present evidence enables clinicians to weigh the benefits and potential harms of plastic surgeries more specifically. Taking body weight into consideration before breast and abdominal reconstructive surgeries seems to be necessary. Perioperative weight management for obese patients is worthy of further investigation and discussion before these 2 reconstructive surgeries. Drs Lin and Chen contributed equally to this work as co-first authors. The authors declared no potential conflicts of interest with respect to the research, authorship, and publication of this article. The authors received no financial support for the research, authorship, and publication of this article.
Source: Aesthetic Surgery Journal
DOI: 10.1093/asj/sjac310
Authors: Dai-Zhu Lin, Yun Chen, Yi-No Kang, Wen-Kuan Chiu
Institutions: Wan Fang Hospital, Taipei Medical University
Language: English
Topic: Body Contouring and Surgery
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W4310348441