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 I) 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, post-weigh loss BMI (Current BMI) was 29.3 ± 5.0 and the δBMI was 22.3 ± 7.5. For all cases (n ≤ 511), the presence of a surgical complication was directly related to Max BMI (P ≤ 0.002) and δBMI (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 δBMI. 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 δBMI 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.
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