Frequency and Risk Factors of Blood Transfusion in Abdominoplasty in Post–Bariatric Surgery Patients

Sir: We read with great interest the article entitled “ Frequency and Risk Factors of Blood Transfusion in Abdominoplasty in Post–Bariatric Surgery Patients: Data from the Nationwide Inpatient Sample.”1 We congratulate the authors on conducting one of the largest studies investigating blood transfusion in abdominoplasty for post–bariatric surgery patients. The Nationwide Inpatient Sample contains procedure information, which is recorded as International Classification of Diseases, Ninth Revision, Clinical Modification codes for procedures. The International Classification of Diseases, Ninth Revision, Clinical Modification code for abdominoplasty is 86.83, which is also used for other body contouring procedures, such as adipectomy; cutaneolipectomy; lipectomy; liposuction; panniculectomy; and size reduction of arms, buttocks, and thighs. Therefore, the information from the Nationwide Inpatient Sample database cannot differentiate abdominoplasty from many other common body contouring procedures. As a result, it is very difficult to determine the exact number of patients that underwent abdominoplasty after bariatric surgery from the Nationwide Inpatient Sample database. We are puzzled by the overall complication rate listed in Table 2. It seems that the overall complication rate should be the sum of all the listed complications, including urinary tract infection, pneumonia, acute kidney injury, venous thromboembolism, and others. The values of the listed complications for the patients with and without transfusion are 34.05 and 7.9 percent, respectively, which are quite different from the numbers listed in the article (10.1 percent for patients with transfusion and 4.8 percent for patients without transfusion). We are wondering about the authors’ calculating process for the overall complication rate. DISCLOSURE None of the authors has a financial interest to declare in relation to the content of this communication. Jiuzuo Huang, M.D. Nanze Yu, M.D. Xiao Long, M.D. Division of Plastic and Reconstructive Surgery Department of Surgery Peking Union Medical College Hospital Beijing, People’s Republic of China