Risk Factors And Complications Of Male Aesthetic Surgery: A Multi-institutional Analysis
Jacquelynn P. Tran, MD, Robert P. Duggan, BS, Stefanos Boukovalas, MD, Linda G. Phillips, MD.
University of Texas Medical Branch, Galveston, TX, USA.
PURPOSE: Gender-based discrepancies in surgical outcomes are well documented in medicine; however, there is a paucity of data within the plastic surgery literature. The purpose of this study is to assess gender-based trends in aesthetic procedures, examine risk factors and complications associated with male aesthetic surgery. METHODS: A retrospective cohort study was performed on all reported aesthetic procedures within the Tracking Operations and Outcomes for Plastic Surgeons (TOPS) database between 2009-2014. All missing/invalid values and gender specific procedures were excluded. Regression analyses were used to characterize all reported patient variables. RESULTS: 41,633 patients were included, 5,451 males and 40,682 females. On bivariate analysis, males were significantly younger, had higher mean BMI, percentage of tobacco use and diabetes. Overall complication rate between males and females did not differ significantly. However, the number of major complications, defined as unplanned ER visit, readmission, or reoperation within 30 days was higher in men (p=0.006). Of all collected CPT codes, body-contouring procedures had the highest complication rates; complications from buttock lift, thigh and abdominoplasty were significantly higher in males compared to females (p< 0.05). On multivariate analysis, male gender was found to be an independent risk factor for hematoma (OR 2.7, p=0.001) and reoperation (OR 1.8, p<0.001). In males regardless of procedure performed, obesity was associated with an adverse event (OR 3.6, p=0.04); combining surgical procedures were associated with seroma (OR 1.9, p<0.001), major complication (OR 3.2, p<0.001) and hematoma (OR 2.9, p=0.02). CONCLUSION: Male gender is a risk factor for hematoma and re-operation independent of BMI, comorbidities and surgery performed. This association is well established in facelift literature due to increased facial perfusion in men, however, these results may suggest other factors at play such as decreased postoperative compliance or earlier return to strenuous activity. Despite these associations, male anesthetic surgery is overall safe with a low major complication rate comparable to females. This is one of the biggest multi-institutional study to date to benchmark surgical outcomes in male aesthetic surgery, it highlights the importance of preoperative counseling, and provides a standard reference that may guide clinical practices in the future.
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