shutterstock_64652209Complications after abdominoplasty are higher than other cosmetic procedures, and this risk increases dramatically when other procedures are performed simultaneously, according to a new study in in the November issue of Plastic and Reconstructive Surgery®.

The researchers assessed abdominoplasty complication rates and risk factors using the nationwide CosmetAssure database. CosmetAssure is an insurance program providing coverage for complications related to cosmetic plastic surgery procedures. The study included nearly 25,000 abdominoplasties performed between 2008 and 2013, representing about 14% of all procedures in the database. Ninety-seven percent of abdominoplasty patients were women; the average age was 42 years. Sixty-five percent of patients underwent abdominoplasty combined with other cosmetic surgery procedures.

Overall, major complications occurred in 4% of patients undergoing abdominoplasty—significantly higher than the 1.4% rate after other cosmetic surgery procedures. (The database didn’t include less serious complications that can be managed in the clinic.) Hematomas were the most common major complication, followed by infections, venous thromboembolism, and lung-related problems.

Combined procedures were a key risk factor for complications. Compared to the 3.1% rate with abdominoplasty alone, risk increased when abdominoplasty was combined with other procedures: up to 10.4% when abdominoplasty was combined with body contouring plus liposuction. After adjustment for other factors, the relative risk of major complications was 50% higher with combined procedures.

Other risk factors for major complications included male sex, age 55 years or older, and obesity. Risk was lower when abdominoplasty was performed in an office-based surgical suite, compared to a hospital or surgical center. “Surgeons often refer patients with major illnesses, such as heart disease, to hospitals, which may be responsible for this observed trend in complications,” the researchers note.

Diabetes and smoking were not associated with a significant increase in complications after abdominoplasty. “That likely reflected Board-certified plastic surgeons’ practice of not offering abdominoplasty to poorly controlled diabetics and recommending strict smoking cessation for at least 4 weeks before and after surgery,” the study authors write.