Increased Prevalence of Psychiatric Conditions in Panniculectomy Patients With Prior Bariatric Surgery: A Nationwide Epic Cosmos Study.

Introduction Patients with established body dysmorphic disorder (BDD) diagnoses are highly likely to be dissatisfied with plastic surgery and may have increased complication rates. Identifying at-risk patients prior to surgery is crucial to achieving patient satisfaction and minimizing adverse effects. This study seeks to assess the prevalence of BDD and associated psychiatric disorders in patients who have undergone panniculectomy and to evaluate potential associations between psychiatric comorbidity and prior bariatric surgery. Materials and methods Data used in this study came from Epic Cosmos (Epic Systems Corporation, Verona, WI, USA), a community collaboration of health systems representing over 233,000,000 patient records from over 1,325 hospitals and 28,900 clinics. All patients at least 18 years of age with an encounter between January 11, 2014, and January 10, 2024 (n=232,933,561) were included, and records were grouped based on procedural history using documented current procedural terminology codes. Prevalence of psychiatric diagnoses was measured using documented International Classification of Diseases (ICD) 10 codes, and 99% confidence intervals were recorded. Odds ratios (OR) were calculated for group comparison, and p<0.01 was used to determine significance. Results Patients who have undergone panniculectomy (n=62,671) demonstrated significantly increased prevalence of BDD (0.182% vs. 0.011%; OR=16.3, p<0.001), anxiety (43.2% vs. 13.5%; OR=4.9 p<0.001), and depression (35% vs. 9.7%; OR=5.0, p<0.001) compared to those who have not undergone the procedure (n=232,870,890). Of the 62,671 patients with a recorded panniculectomy, those who had also undergone bariatric surgery (n=7,313) showed a significantly increased prevalence of BDD (0.397% vs. 0.154%; OR=2.6, p<0.001), anxiety (64.1% vs. 40.5%; OR=2.6, p<0.001), and depression (57% vs. 32.1%; OR=2.8, p<0.001) than those without prior bariatric surgery (n=55,358). Conclusion Patients undergoing panniculectomy are at high risk for BDD and other psychiatric comorbidities that justify formal screening prior to scheduling surgery. Surgeons should maintain a low threshold in seeking psychiatric evaluation for any concerning patients presenting for panniculectomy evaluation, especially in those with a bariatric surgery history, to ensure holistic benefit for their patients. Additionally, psychiatric professionals who understand the stress of elective plastic surgery should be utilized when available.