Assessment Of Adverse Event Risk In Combined Plastic Surgery Procedures Utilizing The Tracking Operations And Outcomes For Plastic Surgeons (tops) Database
Rachel Schafer, BA, Amy Nowacki, PhD, Graham Schwarz, MD.
Cleveland Clinic, Cleveland, OH, USA.
Purpose: Combining several surgical procedures into one operative session is widespread in the field of plastic surgery; however, the implications of this practice are not fully understood. This study aimed to evaluate the rates and characteristics of adverse events associated with combining plastic surgery procedures as compared with outcomes of individual procedures alone. Methods: A retrospective cohort analysis was performed utilizing data between 2016 and 2020 from the TOPS database. The three most frequent combinations for each of the five most commonly performed plastic surgery procedures (augmentation mammaplasty, reduction mammaplasty, trunk liposuction, mastopexy, and panniculectomy) were selected for analysis. The rate of 30-day adverse events, as defined by the TOPS database, served as the primary outcome. Results: A total of 34,133 patients were analyzed, 7,852 of whom had undergone multiple concurrent procedures. The 30-day adverse event rate for individual procedures was 2.0% for patients undergoing trunk liposuction, 2.3% for augmentation mammaplasty, 4.5% for mastopexy, 7.1% for reduction mammaplasty, and 8.7% for panniculectomy. The three most common combinations for augmentation mammaplasty, trunk liposuction, and reduction mammaplasty had higher rates of adverse events compared to index procedures alone (3.6%, p=0.003, 9.9%, p<0.001, and 10.3%, p=0.020, respectively). Conversely, the three most frequent combinations for mastopexy and panniculectomy did not differ in adverse event rates compared to individual procedures alone (4.7%, p=0.705 and 10.8%, p=0.055, respectively). Conclusions: The findings from this study help elucidate the impact of combining procedures and will serve to inform shared surgical decision making and contribute to patient safety.
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