Classification and Treatment Protocol of Post-bariatric Patients: An Anamnestic and Psychiatric Profiling

Post-bariatric surgery is one of the fastest-growing subspecialties in plastic surgery. The increase in the number of surgical procedures has not been followed by an equivalent categorization of patients. Surgical innovations and technical refinements are widespread, while clear classification and objectification of surgical indications are lacking.

A retrospective monocentric study was carried out. We included 135 patients operated in our department of plastic surgery between January 1, 2015, and December 31, 2019. Patients were adults with a history of bariatric surgery. We analyzed two major and two minor criteria before the reconstructive procedure was performed. We divided patients into three clusters (A, B and C) according to the number and nature of major criteria met. We then compared the incidence of postoperative complications and the percentage of body weight regained at 1 year after surgery between the groups. We also tested the impact of minor criteria in each cluster.

Our sample had a mean age of 48.5 years, a mean BMI of 27.68 kg/m², 19 (14.1%) male patients, 116 (85.9%) female patients. We included 81 (60.0%) patients in cluster A; 44 (32.6%) patients in cluster B; and 10 (7.4%) patients in cluster C. Comparison between these groups shows us a higher incidence of postoperative complications in patients in clusters B and C. In addition, patients with diagnosed psychiatric disorders showed a 70% complication rate (p = 0.038) while we found no significant correlations with the other criteria analyzed.

The classification proposed based on our criteria may represent a first step toward classifying post-bariatric patients and reinforcing the surgical indication in these patients. It also enables us to identify the patients who are most at risk of complications.

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