Silent Saboteur: Hypertension is a Significant Risk Factor for Complications After Cosmetic Abdominoplasty

Abstract Background Hypertension has a global prevalence of over 30% in the adults and is associated with adverse surgical outcomes. However, its specific impact on postoperative complications in cosmetic abdominoplasty remains underexplored. Objectives To evaluate the association between medically treated hypertension and 30-day postoperative complications following elective cosmetic abdominoplasty. Methods The ACS-NSQIP database (2008-2022) was retrospectively analyzed for adult patients undergoing elective cosmetic abdominoplasty. All patients were categorized into two groups: those medically treated for hypertension (MedHyp) and those without (NoMedHyp). Univariate analysis, multivariate logistic regression, and propensity score matching (PSM) evaluated 30-day postoperative outcomes. Results Of 1,791 patients, 1,457 (81%) were NoMedHyp group (mean age: 43.9 ± 10.5 years; BMI: 28.2 ± 5.8 kg/m2) and 334 (19%) MedHyp (mean age: 52.5 ± 10.6 years; BMI: 31.1 ± 6.2 kg/m2; both p < 0.001). The overall complication rate was 6.0% (n = 107), with 4.8% (n = 70) in NoMedHyp and 11% (n = 37) in MedHyp (p < 0.001). Multivariate analysis showed hypertension was significantly associated with increased odds of overall (OR: 2.35, p < 0.001) and surgical complications (OR: 2.91, p < 0.001), including deep incisional infections (OR: 4.67, p = 0.04) and bleeding requiring transfusion (OR: 6.81, p < 0.001). After PSM (balancing age, BMI, and race), hypertension remained significantly associated with higher overall (OR: 3.08, p < 0.001) and surgical complications (OR: 3.44, p = 0.003), including bleeding requiring transfusion (OR: 9.22, p = 0.04). Conclusions Hypertension is a significant risk factor for postoperative complications in cosmetic abdominoplasty, particularly for surgical complications and bleeding.