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

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 1) 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/m(2), post-weigh loss BMI (Current BMI) was 29.3 +/- 5.0 and the Delta BMI was 22.3 +/- 7.5. For all cases to (n = 511), the presence of a surgical complication was directly related to Max BMI (P = 0.002) and Delta BMI (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 Delta BMI. 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 Delta BMI 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.