Developing the aesthetic postoperative complication score (APeCS) for detecting major morbidity in racial aesthetic surgery


Advocate Illinois Masonic Medical Center


Background:Facial aesthetic surgery encompasses a variety of procedures with complication rates that are difficult to estimate due to a lack of published data.

Objectives:We sought to estimate major complication rates in patients undergoing facial aesthetic procedures and develop a risk assessment tool to stratify patients.

Methods:We utilized the Tracking Operation and Outcomes for Plastic Surgeons (TOPS) database from 2003-2018. The analytic database included major facial aesthetic procedures. Univariate analysis and a backward stepwise multivariate regression model identified risk factors for major complications. Regression coefficients were used to create the score. Area under receiver operating characteristic (ROC) curves and sensitivity analyses were used to measure performance robustness.

Results:A total of 38,569 patients were identified. The major complication rate was 1.2% (460). The regression model identified risk factors including over three concomitant surgeries, BMI ≥25, ASA class ≥2, current/former smoker status, and age ≥45 as the variables fit for risk prediction (n = 13,004; AUC: 0.68, SE: 0.013, [0.62-0.67]). Each of the five variables counts for one point except over three concomitant surgeries counting for two, giving a score range from 0-6. Sensitivity analysis showed the cutoff point of ≥3 to best balance sensitivity and specificity, 58% and 66%, respectively. At this cutoff, 65% of cases were correctly classified as a major complication.

Conclusions:We developed an acceptable risk prediction score with a cutoff value of ≥3 associated with correctly classifying approximately 65% of those at risk for major morbidity when undergoing face and neck aesthetic surgery.

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