Patient Characteristics and Spending Among Individuals Undergoing Ambulatory Panniculectomy and Abdominoplasty in the US from 2016 to 2019

Goals/Purpose: Weight reduction following dietary modification and exercise, childbirth, or bariatric surgery can result in redundant soft tissue and skin folds. Individuals with excessive skin and subcutaneous tissue may report disabling complications including difficulty ambulating, interference with exercise, and infections of the intertriginous regions. These conditions may affect employment leading to social and health disparities. Other individuals with less severe laxity may not be limited functionally but seek to change their cosmesis. As our healthcare system advances the management of obesity and the incidence of bariatric surgery increases, more patients are seeking abdominal contouring surgeries such as functional panniculectomy and cosmetic abdominal surgery. For plastic surgeons, who frequently perform these procedures in outpatient surgery centers, data about patterns of delivery and clinical characteristics of patients are of key importance. Such data are limited in the ambulatory surgery setting. We investigated national patterns and patient demographics for abdominal contouring surgery among all payers in the ambulatory surgery setting from 2016 to 2019.

Methods/Technique: Using the Nationwide Ambulatory Surgery Sample (NASS), we performed an observational cross-sectional analysis of outpatient abdominal contouring procedures between 2016 and 2019. The NASS is an all-payer surgery database that captures approximately 11.8 million ambulatory surgery procedures performed in the United States annually. Encounters with a Current Procedural Terminology code 15830 were included. Encounters with International Classification Disease code Z41.1 or CPT 15847 modifiers were defined as cases of cosmetic abdominoplasty, whereas functional panniculectomy was defined as encounters without these modifiers based on guidelines from the American Society of Plastic Surgeons. Demographic and clinical characteristics were recorded for each encounter. Race and ethnicity information was only available in 2019. The total charges were adjusted for inflation, and observations were weighted to be nationally representative using weights provided by the NASS. This study followed the STROBE reporting guideline and was deemed exempt from review by the Vanderbilt University institutional review board. Changes in patterns over the study period were compared using Pearson χ² tests with Rao Scott corrections and logistic regression for categorical variables and linear regression for continuous variables. Analyses were computed in Stata version 17 (StataCorp LP, College Station, Texas, United States), and statistical significance was defined as a 2-sided α<.05.

Results/Complications: A weighted estimate of 95,289 encounters for (66,531[69.8%] functional panniculectomy and 28,758 [30.2%] cosmetic abdominoplasty) abdominal contouring surgery were included. The median age for abdominal contouring surgery was 46 for functional panniculectomy and 44 for cosmetic abdominoplasty. Most abdominal contouring surgeries were performed in women (92.9%; 95% CI, 92.6%-93.3%). Between 2016 and 2019, the annual number of abdominal contouring surgeries increased by 9.6% (22,645 in 2016 vs 24,814 in 2019) and by 28.5% (4,866 in 2016 vs 6,254 in 2019) among patients with a history of bariatric surgery (23.8%; 95% CI, 22.3%-25.4%).

Most functional panniculectomies were covered by government insurance (27.4%; 95% CI, 36.4%-39.9%) while cosmetic abdominoplasty was primarily paid for by patients (74.0%; 95% CI, 70.5%-77.2%). More patients undergoing cosmetic abdominoplasty (39.1%; 95% CI, 34.8%-43.4%) had a median income of greater than $82,000 compared to those who underwent functional panniculectomy (26.7%; 95% CI, 25.2%-28.3%). Concurrent ventral hernia repair was performed in 6.2% (95% CI, 5.8%-6.7%) of encounters for functional panniculectomy. Comorbidities including scarring (OR, 1.49; 95% CI, 1.29-1.72) were more common among patients undergoing functional panniculectomy (P<.001).

In 2019, patients who underwent functional panniculectomy were more racially diverse than those who underwent cosmetic abdominoplasty (P<.001). Compared to White patients, Black (OR, 1.59; 95% CI, 1.19-2.14) and Hispanic (OR, 1.36; 95% CI, 1.08-1.72) patients were more likely to have functional panniculectomy than cosmetic abdominoplasty. Black (OR, 1.31; 95% CI, 1.13-1.53) and Hispanic (OR, 1.30; 95% CI, 1.08-1.57) patients were also more likely to have a history of bariatric surgery. Median (IQR) total charges for abdominal contouring surgery were $32,741 ($21,717-$49,897). There was no significant difference in total charges between functional panniculectomy and cosmetic abdominoplasty. Median total charges increased by 23.6% over the study period (P<.001).

Conclusion: Our analysis expands on prior research by describing demographic trends and spending patterns among individuals undergoing outpatient functional panniculectomy and cosmetic abdominoplasty. The incidence of abdominal contouring surgeries has increased moderately over recent years especially in individuals with a history of bariatric surgery. In contrast to previously reported data, most abdominal contouring surgeries were coded as panniculectomy with public or private insurance as primary payers. Compared to cosmetic abdominoplasty, patients who underwent functional panniculectomy were more racially diverse and had lower median incomes. Comorbidities were also higher in patients who underwent functional panniculectomy. Total charges increased over the study period but did not differ between functional panniculectomy and cosmetic abdominoplasty.

Limitations include the use of diagnosis and procedure codes to identify patients, the absence of outcomes information and cost-to-charge ratios, and sampling error.