Invited Discussion on: Abdominoplasty and Patient Safety: The Impact of Body Mass Index and Bariatric Surgery on Complic
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EDITOR’S INVITED COMMENTARY
Invited Discussion on: Abdominoplasty and Patient Safety: The Impact of Body Mass Index and Bariatric Surgery on Complications Profile Fabio Xerfan Nahas1
Received: 23 April 2020 / Accepted: 28 April 2020 Ó Springer Science+Business Media, LLC, part of Springer Nature and International Society of Aesthetic Plastic Surgery 2020
Level of Evidence V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266. In this study, the authors have retrospectively analyzed 191 patients who underwent abdominoplasty to evaluate the risk of complications in obese and bariatric patients. It is well known that abdominoplasty has a high incidence of medical lawsuits among cosmetic surgeries [1]. It is also known that for patients seeking abdominoplasty, the prevalence of body dysmorphic disorder symptoms is 57% and 51% of the patients in two previous studies [2, 3]. Therefore, this previous condition is an issue to be considered when operating on these patients. To decrease the risk of complications will improve how patients evaluate the outcome of a cosmetic surgery and its impact on quality of life, self-esteem [4] and sexuality [5]. Grazer and Goldwin in 1977 [6] presented a survey with plastic surgeons of the American Society of Plastic Surgery in which they have evaluated the main complications in abdominoplasty displaying a very high incidence of thromboembolic phenomena, infection and hematoma. Almost 30 years later, Matarasso et al. did a similar survey with surgeons who operated on approximately 11,000 patients and have shown that there was a significant decrease in most complications, especially in the incidence of DVT and pulmonary emboli [7]. This demonstrates that the total number of complications has decreased along the
& Fabio Xerfan Nahas [email protected] 1
years. Now, the authors of this study aim to map the risk in patients with special preexisting conditions. The endocrine–metabolic response to trauma is directly related to its magnitude. Obese and bariatric patients may have a more extensive response due to the extension of the procedure. Operating time has been the factor that most influenced increase in plasma concentrations of stress markers in a level 1 evidence study [8]. Therefore, the objective of this study is completely justified. The authors have classified complications into two groups of major and minor complications, depending on the need for hospitalization and/or reoperation. This is an interesting point of view. However, some complications, depending on intensity, may be classified as major or minor. An example is infection. A localized cellulite in the abdominal skin is classified as a minor complication and can be controlled at home, whereas a more extensive infection requires hospitalization and is considered a major complication. It is hard to evaluate the shades of gray in
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