Pulmonary Embolism Risk in Geriatric Panniculectomy: An NSQIP Analysis.

[INTRODUCTION] As more elderly patients pursue body contouring after massive weight loss, understanding their risk profiles is critical. Prior studies grouped complications together, but none have specifically examined pulmonary embolism (PE) in geriatric panniculectomy, despite reports of elevated PE risk in abdominoplasty and the predictive value of frailty.

[METHODS] The ACS NSQIP database (2005-2017) was queried for panniculectomy cases (CPT 15830). Patients 65 years or older were classified as geriatric. Demographics, comorbidities, and perioperative factors were compared between groups. Logistic regression identified predictors of PE and complications, with secondary analysis restricted to geriatric patients.

[RESULTS] Of 11,708 cases, 1005 (9%) were geriatric (mean age, 69 ± 3.7 years). Geriatric patients had higher rates of hypertension, insulin-dependent diabetes, dyspnea at rest, and poor functional status (all P < 0.001). Pulmonary embolism occurred in 8 of 1005 geriatric patients (0.8%) compared with 32 of 10,703 nongeriatric patients (0.3%) ( P = 0.01). On multivariable analysis, geriatric age independently conferred a 3-fold increase in PE risk (aOR, 3.1; 95% CI, 1.34-7.1; P < 0.01). Within the geriatric cohort, obesity (aOR, 1.6; P < 0.01), dyspnea at rest (aOR, 1.6; P = 0.05), poor functional status (aOR, 2.0; P = 0.04), antihypertensive use (aOR, 1.7; P = 0.02), and inpatient surgery (aOR, 2.7; P < 0.001) independently predicted complications.

[CONCLUSIONS] Geriatric patients undergoing panniculectomy face significantly higher PE risk, echoing abdominoplasty data showing delayed venous thromboembolism. Surgical morbidity appears driven by comorbidities and physiologic reserve rather than age alone. These findings underscore the importance of careful preoperative risk stratification and support the need for prospective evaluation of perioperative thromboprophylaxis strategies in elderly patients.