Weighing the Risk: The Impact of Obesity on 30-Day Complications After Cosmetic Abdominoplasty-An Observational Cohort Study of 1,778 Cases.

[BACKGROUND] Obesity's impact on postoperative outcomes in abdominoplasty remains poorly defined despite its rising prevalence. This study evaluates the effect of obesity on 30-day postoperative complications to inform risk assessment and management.

[OBJECTIVES] Investigate the effect of obesity on 30-day postoperative complications following abdominoplasty.

[METHODS] We analyzed data from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) for patients who underwent abdominoplasty between 2008 and 2022. Patients were categorized into obese (BMI ≥ 30 kg/m) and non-obese (BMI < 30 kg/m) groups. Univariate and multivariate analyses were performed to compare 30-day postoperative complication rates between the groups.

[RESULTS] A total of 1,778 patients were included; 618 (34.8%) had obesity (mean BMI 35.2 ± 5.0 kg/m) and 1,160 (65.2%) did not (mean BMI 25.2 ± 2.9, p < 0.001). Average age of patients with obesity (45.0 ± 10.4 years) was comparable to those without (45.8 ± 11.4, p > 0.99). Postoperative complications occurred in 107 cases (6.0%), with a significantly higher incidence in patients with obesity (8.9% vs. 4.5%, p = 0.002). Deep vein thrombosis (DVT) occurred more frequently among patients with obesity (1.3% vs. 0.1%, p = 0.04). Obesity was associated with significantly increased overall complications (OR 1.79, p = 0.01), surgical complications (OR 1.68, p = 0.046), superficial wound infections (OR 2.23, p = 0.02), and unplanned readmissions (OR 2.75, p = 0.01).

[CONCLUSION] Obesity is an independent risk factor for complications following abdominoplasty. Optimized preoperative screening, potentially including DVT prophylaxis for patients with obesity, and tailored perioperative care are essential to improving outcomes in this population. Evidence-based guidelines are needed to enhance surgical safety for obese patients.

[LEVEL OF EVIDENCE III] This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .