90. Disparities In Healthcare Utilization After Panniculectomy

PURPOSE: Obesity is rising in the United States, with a consistent increase from 30.5% to 41.9% between 1999 and 2020. As a result, bariatric surgery, as well as subsequent body contouring surgeries have also increased in prevalence. There remains a paucity of literature regarding the impact of demographic factors on outcomes for body contouring procedures. The goal of this study was to determine the effect of social determinants of health such as socioeconomic status, race, sex, comorbid illness, and insurance status on overall complications and healthcare utilization following panniculectomy surgery. METHODS: A retrospective review of 231 patients who underwent a panniculectomy at our institution between January 2005 and May 2023 was performed. Medical household income, geographical location, race, sex, ethnicity, and insurance status were assessed as the primary measures. Exclusion criteria included abdominal wall repair and concurrent gynecologic or urologic procedures. Postoperative outcomes were defined as complication rate (wound dehiscence, seroma formation, hematoma, hypertrophic/keloid scarring, infection), reoperation rate, length of hospital stay, and total length of follow up in months. RESULTS: At our institution, socioeconomic factors such as median household income, insurance status, or distance of the patient’s residence from the hospital did not affect rate of overall complications or the level of healthcare utilization by patients, including length of postoperative stay, total number of follow-up visits, and total length of follow-up. Insurance status and median household income did not significantly affect the panniculectomy type (horizontal, fleur de lis±umbilical transposition). Notably, increased distance from the patients’ residence to the hospital was associated with higher rates of return to OR, as well as higher rates of infection and seroma formation. Increased age was associated with increased length of hospital stay (r = 0.231, p <0.001) and with increased number of follow-up visits (r = 0.192, p = 0.003). Higher BMI was associated with higher rates of infection. Hematoma complications were identified to be more prevalent in males. CONCLUSION: Data reveal that at our institution, patients received equitable levels of healthcare and socioeconomic factors did not significantly influence healthcare utilization regardless of median household income or insurance status. A similar study investigating disparities in abdominal wall reconstruction as well as several other studies analyzing breast reconstruction outcomes revealed that lower household income was associated with higher rates of complication. Institutional differences such as hospital location, patient population characteristics, and post-operative practices must be investigated to illuminate the differences in our results. In addition, further analysis is warranted to explore the relationship between increased distance from the hospital vs. the higher rates of return to OR and infection rate. Patient reluctance to return to the hospital upon experiencing signs of complications due to increased travel time or financial burdens may be a possibility. To the best of our knowledge, we are the first to investigate the socioeconomic implications of this highly sought-after body contouring surgery.