Body Mass and Surgical Complications in the Postbariatric Reconstructive Patient: Analysis of 511 Cases

In Brief Objective: To analyze the impact of body mass indices on postbariatric reconstructive surgery complications. Background: An increasing number of patients are presenting after massive weight loss due to bariatric surgery or diet and exercise. Many of these patients have residual obesity, which may compromise outcomes. Methods: 449 patients were enrolled in a prospective registry over 6 years. Measures included medical complications and comorbidities. All cases were analyzed together as well as in two subgroups: single procedure cases (Group I) and multiple procedure cases (Group II). Results: 449 patients (407 female, 42 male) with a mean age of 44.5 ± 10.3 underwent 511 separate operations. Mean pre-weight loss BMI (Max BMI) was 51.6 ± 9.5 kg/m2, post-weigh loss BMI (Current BMI) was 29.3 ± 5.0 and the ΔBMI was 22.3 ± 7.5. For all cases (n = 511), the presence of a surgical complication was directly related to Max BMI (P = 0.002) and ΔBMI (P = 0.002) but not Current BMI. Group I consisted of 194 single procedure cases. Complications in Group I were related to Max BMI (P = 0.006) and Current BMI (P = 0.02) but not ΔBMI. Max BMI impacted infections (P = 0.003) while Current BMI impacted dehiscence (P = 0.009) and infections (P = 0.03). Group II consisted of 317 cases with only ΔBMI directly related to overall complications (P = 0.01). Conclusions: Body mass indices influence complications in postbariatric reconstructive surgery. Current BMI may impact complications in single-procedure cases, but appears to play less of a role in larger cases. Careful patient selection, assessment of surgical complexity, and recognition of the particular risks increased by residual obesity can help to optimize outcomes in this patient population. Residual obesity is a persistent problem in the postbariatric patient, posing unknown implications for elective surgery. Massive weight loss patients were analyzed to examine the value of body mass in predicting complications. While increased body mass did raise the risk of certain complications, no evidence was found for a strict cutoff at which surgery should be postponed pending further weight loss.