Complications in post-bariatric body contouring surgery using a practical treatment regime to optimise the nutritional state

D J S Makarawung; M Al Nawas; H J M Smelt; V M Monpellier; L M Wehmeijer; W B van den Berg; M M Hoogbergen; A B Mink van der Molen

doi:10.1016/j.jpra.2022.06.006

Complications in post-bariatric body contouring surgery using a practical treatment regime to optimise the nutritional state

JPRAS Open. 2022 Jun 29:34:91-102. doi: 10.1016/j.jpra.2022.06.006. eCollection 2022 Dec.

Authors

D J S Makarawung¹, M Al Nawas¹, H J M Smelt², V M Monpellier³, L M Wehmeijer⁴, W B van den Berg¹, M M Hoogbergen⁴, A B Mink van der Molen⁵

Affiliations

¹ Department of Plastic, Reconstructive and Hand Surgery, St. Antonius hospital, Koekoekslaan 1, 3435 CM, Nieuwegein, the Netherlands.
² Department of General Surgery, Catharina Hospital, Michelangelolaan 2, 5623 EJ, Eindhoven, the Netherlands.
³ Nederlandse Obesitas Kliniek (Dutch Obesity Clinic), Huis ter Heide, the Netherlands.
⁴ Department of Plastic, Reconstructive and Hand Surgery, Catharina hospital, Michelangelolaan 2, 5623 EJ, Eindhoven, the Netherlands.
⁵ Department of Plastic, Reconstructive and Hand Surgery, UMC Utrecht, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands.

Abstract

Background: Post-bariatric body contouring surgery (BCS) treats redundant skin after massive weight loss; however, the complication risk is relatively high (23-70%). Most complications are wound-related, which may be partly due to a poor nutritional status after bariatric surgery. The objective of this observational study was to optimise nutrition preoperatively and assess the prevalence of wound-related complications after BCS.

Methods: This prospective cohort study included 140 patients. Patients were treated according to the post-bariatric BCS guideline. Nutritional parameters were collected via pre- and peri-operative blood sampling; any deficiencies were treated. A protein-enriched diet was prescribed by a dietician 4 weeks preoperatively up until closure of all wounds. Complications were recorded using the Clavien-Dindo classification. Univariate and multivariate regression analyses were performed to identify variables associated with wound-related complications.

Results: The overall wound-related complication rate was 51%. Most complications were minor, with only 4.3% was considered major. No significant differences in patient characteristics were found between patients with and without complications. Variables indicating an optimised nutritional state were not significantly associated with a decreased risk of complications; the most influential factor was a sufficient post-operative protein intake (OR 0.27, 95% CI 0.07 - 1.02, p = 0.05).

Conclusion: The overall wound-related complication rate was in accordance with previous literature; however, major complications were few. This study showed a weak correlation between optimising nutritional state and better outcome after BCS, especially following a protein-enriched diet post-operatively. Therefore, we recommend continuing research on nutrition and wound-related complications, using homogeneous study populations and well-defined complications.

Keywords: Body contouring surgery (BCS); bariatric surgery; complications; nutrition; wound healing.