Is it Time to Reevaluate Our Body Mass Index Cutoff in Body Contouring Surgery? An Assessment of the Preferred Cutoff Values to Minimize Venous Thromboembolism and Wound Complications

INTRODUCTION: Obesity has been linked extensively to adverse outcomes, such as wound complications and venous thromboembolisms (VTEs), for patients undergoing plastic surgery, especially regarding body procedures.1 However, most surgeons utilize variable and arbitrary body mass index (BMI) cutoffs. The purpose of this study was to reevaluate an optimal BMI cutoff to avoid complications in elective body contouring procedures. METHODS: The 2010-2020 National Surgical Quality Improvement Program (NSQIP) database was queried for patients undergoing an infraumbilical panniculectomy including a lipectomy (CPT = 15830). A binary logistic multivariable regression was run to determine any significant preoperative variables associated with either wound complications or VTEs. Patients were excluded if they possessed any preoperative variables that were statistically significant in our regression for each of those complications. For both the VTE and wound complication cohorts, a receiving operating characteristics (ROC) curve was generated with a 95% confidence and a Youden’s Index (J) calculated with the highest J determining the optimal BMI cut-off values. RESULTS: A total of 10,241 patients were included for analysis in the wound complication cohort. Within this cohort, 520 (5.1%) patients experienced wound complications. For the VTE complication cohort, 16,123 patients were included for analysis with an overall VTE complication rate of 0.8% (n = 130). The area under the curve (AUC) for the wound complication and VTE cohort was 0.643 and 0.613 respectively. The optimal BMI cutoff based on the J statistic for the wound complication cohort was 30.5 while for the VTE cohort it was 28.2. CONCLUSIONS: Our research determined that the optimal BMI cutoffs to avoid VTEs and wound complications in patients undergoing abdominal contouring procedures are 28.2 and 30.5 respectively. These values can be utilized to guide shared decision making in patients undergoing elective body contouring surgery. References: 1. Joslyn NA, Esmonde NO, Martindale RG, Hansen J, Khansa I, Janis JE. Evidence-Based Strategies for the Prehabilitation of the Abdominal Wall Reconstruction Patient. Plastic and Reconstructive Surgery. 2018;142(3S):21S. doi:10.1097/PRS.0000000000004835