The Association Between Metabolic Derangement and Wound Complications in Elective Plastic Surgery.
Diabetes
Metabolic syndrome
Obesity
Operative time
Plastic surgery
Wound healing
Journal
The Journal of surgical research
ISSN: 1095-8673
Titre abrégé: J Surg Res
Pays: United States
ID NLM: 0376340
Informations de publication
Date de publication:
10 2022
10 2022
Historique:
received:
02
10
2021
revised:
17
02
2022
accepted:
19
03
2022
pubmed:
20
5
2022
medline:
27
7
2022
entrez:
19
5
2022
Statut:
ppublish
Résumé
The incidence of metabolically unhealthy obesity is rising nationally. In this study, we compare wound and overall complications between metabolically unhealthy obese and healthy patients undergoing elective plastic surgery and model how operative time influences a complication risk. Patients undergoing elective breast and body plastic surgery procedures in the 2009-2019 National Surgical Quality Improvement Program (NSQIP) dataset were identified. Complications were compared between metabolically unhealthy obese (body mass index [BMI] > 30 with diabetes and/or hypertension) versus metabolically healthy obese patients (BMI > 30 without diabetes or hypertension). Logistic regression was used to model the probability of wound complications across operative times stratified by metabolic status. Of 139,352 patients, 13.4% (n = 18,663) had metabolically unhealthy obesity and 23.8% (n = 33,135) had metabolically healthy obesity. Compared to metabolically healthy patients, metabolically unhealthy patients had higher incidence of wound complications (6.9% versus 5.6%; P < 0.001) and adverse events (12.4% versus 9.6%; P < 0.001), in addition to higher 30-d readmission, returns to the operating room, and length of stay (all P < 0.001). After adjustment, BMI (Odds ratio [OR] 7.86), hypertension (OR 1.15), and diabetes (OR 1.25) were independent risk factors for wound complications (all P < 0.001). Among metabolically unhealthy patients, the operative time was log-linear with a wound complication risk (OR 1.21; P < 0.001). Diabetes and hypertension are additive risk factors with obesity for wound complications in elective plastic surgery. Among patients with metabolically unhealthy obesity, a risk of wound complications increases logarithmically with operative time. This distinction with regard to metabolic state might explain the unclear impact of obesity on surgical outcomes within existing surgical literature.
Identifiants
pubmed: 35588573
pii: S0022-4804(22)00165-2
doi: 10.1016/j.jss.2022.03.017
pmc: PMC9329200
mid: NIHMS1809490
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
39-48Subventions
Organisme : NCI NIH HHS
ID : R01 CA222170
Pays : United States
Organisme : NCI NIH HHS
ID : U01 CA243004
Pays : United States
Informations de copyright
Copyright © 2022 Elsevier Inc. All rights reserved.
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