Bariatric Surgery Before Abdominoplasty Is Associated with Increased Perioperative Anemia, Hemoglobin Loss and Drainage Fluid Volume: Analysis of 505 Body Contouring Procedures

<b>Background</b>: The global rise in obesity rates has led to an increase in bariatric procedures, resulting in more patients needing relief from excess skin through body contouring surgeries (BCS), such as abdominoplasty. Although these procedures are generally considered safe, they can be associated with notable perioperative complications, including increased Hb-loss (hemoglobin loss) and drainage fluid volumes. Thus, this study analyzed risk factors for prolonged fluid secretion after abdominoplasty. <b>Methods</b>: We retrospectively analyzed 505 body contouring procedures performed between January 2018 and December 2023 at the Department of Plastic Surgery at the University Clinic of St. Poelten. The investigation focused on postoperative Hb-loss, drainage fluid volumes and hemoglobin levels in patients, comparing those with and without prior bariatric surgery. Statistical analyses utilized the <i>t</i>-test for Equality of Means, while correlation analyses were conducted using Spearman Rho and the Mann-Whitney U test. <b>Results</b>: Bariatric patients demonstrated markedly reduced hemoglobin levels both preoperatively (13.24 g/dL) and postoperatively (10.68 g/dL) compared to their non-bariatric counterparts (14.02 g/dL preoperatively and 11.71 g/dL postoperatively; <i>p</i> < 0.001). The prevalence of anemia was likewise substantially higher in the bariatric cohort, rising from 14.52% preoperatively to 82.48% postoperatively, versus 6.25% and 61.25%, respectively, in the non-bariatric group (<i>p</i> = 0.001). Moreover, prior bariatric surgery was significantly associated with increased postoperative drainage volume (<i>p</i> = 0.009) and prolonged operative time (<i>p</i> = 0.002). Notably, extended hospital stays exhibited a strong correlation with postoperative anemia (<i>p</i> = 0.005). <b>Conclusions</b>: Collectively, our findings underscore the potential risk of increased hemoglobin loss at BCS after bariatric weight loss. Tailored hemoglobin management and nutritional strategies are essential to improve the outcomes and safety of post-bariatric BCS. Meticulous preoperative identification of hematological discrepancies and adequate patient preparation are imperative for positive postoperative patient safety.