Factors Associated With And Change In Quality Of Life Before And After Body Contouring Procedures
Michael Tecce, DO, Arturo J. Rios-Diaz, MD, Jessica R. Cunning, MBA, Sameer Shakir, MD, Omar Elfanagely, MD, Cutler Whitely, BS, Robyn B. Broach, PhD, Joseph M. Serletti, MD, John P. Fischer, MD, MPH.
University of Pennsylvania, Philadelphia, PA, USA.
Purpose: Body contouring procedures are increasing in popularity among patients with excess skin after weight loss whose health-related quality of life (QoL) is affected. We aimed to (1) ascertain patient demographics and medical history associated with the lowest preoperative QoL, (2) quantify the QoL benefit of body contouring procedures, and (3) examine if the benefit differs based on obesity classification.
Methods: We identified patients seeking consultation for body contouring procedures between 2018-2019 who had a preoperative Body-Q questionnaire completed (score range: 0-100). Patient characteristics and surgical outcomes were extracted. Chi-squared tests were used to determine the characteristics associated with low preoperative QoL by comparing lowest versus highest tertiles for each Body-Q domain. Paired Wilcoxon signed-rank tests served to compare preoperative to postoperative change in patients' QoL. Chi-squared tests were used to determine QoL differences by obesity class: Class 1-2 (BMI=30-39.9kg/m2) versus Class 3 (BMI>40kg/m2).
Results: The preoperative Body-Q assessment was completed by 147 patients during the study period. Median age was 50 (interquartile range [IQR] 38-55), and the majority were Black (57%), non-Hispanic (95%), privately insured (66%), non-diabetic (83%), non-smokers (65%), non-hypertensive (62%), American Society of Anesthesiologists classification III (54%), obese (71%), and had a history of bariatric surgery (76%). Preoperative factors associated with low QoL included age >55, Black race, public insurance, hypertension, obesity, history of bariatric surgery and ASA III (p<0.05; Table).
Of patients who completed a preoperative Body-Q, 53 (36%) underwent surgery. Thirty-five of these surgical patients (66%) completed both surveys. The majority underwent panniculectomy or abdominoplasty (94%), were 50 years-old (IQR 41-55), Black (51.4%), privately insured (68.6%), covered by insurance (82.9%), obese (BMI>30 77.1%), and had history of bariatric surgery (85.7%). Surgical site occurrence, including hematoma, seroma, infection, fat necrosis, skin necrosis, and delayed healing, occurred in 40% of the cohort. Postoperative QoL improved in 10/10 Body-Q domains (p<0.01; Figure) and was not impacted by SSOs in any domain (p>0.05). Obesity classification did not affect the change in QoL (Class 1-2 vs. Class 3, p>0.05).
Conclusions: QoL is significantly lower at baseline in older, Black, publicly insured, multimorbid, and obese patients but improves dramatically after body contouring procedures. The benefit extends across physical, psychosocial and sexual well-being and does not seem to be impacted by complications or degree of obesity.
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