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Heterogeneity in Body Contouring Outcomes Based Research: The Pittsburgh Criterion
RA Guest, JA Gusenoff, MD
University of Pittsburgh School of Medicine
2016-01-26
Presenter: RA Guest
Affidavit:
This project represents the original work of Rachel Guest. This project has not been published in a scientific journal, nor has it been presented previously at a major meeting.
Director Name: Joseph E Losee, MD, FAAP, FACS
Author Category: Medical Student
Presentation Category: Clinical
Abstract Category: Aesthetics
PURPOSE:
Body contouring complications after massive weight loss (MWL) vary significantly in frequency and type. Currently, no standardized recommendations exist regarding which complications are most important to report. A criterion for complication reporting will aid in informing patients of complications perioperatively.
METHODS:
The authors reviewed the literature for the terms "body contouring surgery," "MWL," and "complications." Papers were eliminated based on: non-English language, case report, meta-analysis, outpatient, non-MWL, unclear demographics, N<30 and lack of numeric results. Data was analyzed together and as two separate groups: Group 1 (truncal contouring) and Group 2 (extremity contouring).
RESULTS:
88 papers were reviewed and 24 met inclusion criteria. The weighted mean rates for complications are as follows. In group 1: dehiscence (15.5%), seroma (5.5%), scarring (2.9%), infection (8.2%), necrosis (7.0%), DVT/PE (1.4%), death (0.3%), lymphedema (1.0%). In group 2: dehiscence (19.5%), seroma (18.5%), hematoma (2.1%), scarring (15.5%), infection (7.5%), necrosis (1.9%), DVT/PE (0%), death (n/a), lymphedema (5.0%). Overall, dehiscence (15.1%), seroma (13.2%), hematoma (4.4%), scarring (7.9%), infection (7.1%), necrosis (5.2%), DVT/PE (1.2%), death (0.3%), lymphedema (3.2%).
Scarring included scar revisions, hypertrophic scarring, and general scarring. Scarring was not usually defined. Lymphedema was seldom reported in both groups, and suture extrusion was not reported in any selected papers. Meta-analysis of complications in Group 1 vs. Group 2 suggests significant heterogeneity due to variable complication reporting.
CONCLUSIONS:
Heterogeneity amongst selected studies is explained by variability in how complications are defined. The Pittsburgh Criterion provides specific recommendations on complication reporting in massive weight loss body contouring surgery.
