BACKGROUND: Patients frequently present for body contouring after massive weight loss resulting from bariatric procedures or diet and exercise. The authors investigated whether body contouring complications vary by weight loss method. METHODS: Four hundred forty-nine patients (511 cases) were entered into a prospective registry. Diet and exercise patients were matched to bariatric patients based on identical procedures performed. Conditional logistic regression was used to test for differences between groups. One-to-one matching was then performed by nearest neighbor matching to the most similar patient who underwent bariatric procedures based on sex, age, and body mass index. The t test was used to compare matched patients. RESULTS: Twenty-nine patients (6.5 percent) lost weight exclusively through diet and exercise. They had significantly higher preoperative hematocrit (p = 0.02) and hemoglobin (p = 0.05), and tended to have multiple procedures performed at the same time, higher absolute complication rates, and significantly higher infection rates (p = 0.03). When matched to 191 bariatric patients based on procedures performed, diet and exercise patients had a higher complication rate that did not reach significance (odds ratio, 1.5; p = 0.28). One-to-one matching resulted in 34 procedure-matched pairs with nonsignificant trends toward better nutrition and more complications in diet and exercise patients. CONCLUSIONS: Infection rates were higher in patients who had body contouring after massive weight loss from diet and exercise versus bariatric procedures. When matched, despite lower nutrition markers, patients treated with bariatric procedures had outcomes similar to those of diet and exercise patients. We did not find evidence for an association between weight loss method and risk in the body contouring patient.
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