Postoperative Transfusion in Massive Weight Loss Body Contouring Surgery: A Single-center Retrospective Cohort Study.

BACKGROUND: Patients undergoing body contouring after massive weight loss (MWL) are at an increased risk for anemia and perioperative complications. However, data regarding transfusion patterns and procedure-related transfusion burden in this population remain limited. METHODS: We retrospectively reviewed 224 MWL patients who underwent 385 procedures at a single tertiary referral center from January 2021 to December 2022. Demographic, hematologic, and surgical variables were analyzed. Procedures were categorized as lower body lift (LBL), other multiple combined procedures, or single procedures. The primary outcome was postoperative transfusion, defined by hemoglobin less than 7.5 g/dL with symptoms or persistent decline. Exploratory multivariable logistic regression analysis was performed to evaluate associations between procedure type and postoperative transfusion while accounting for the limited number of events. This study adheres to STROBE reporting guidelines. RESULTS: Fourteen patients (6.3%) required transfusion. Most transfusions occurred in patients undergoing LBL procedures (9 of 14). In exploratory multivariable analysis, LBL remained associated with transfusion (odds ratio: 3.69; 95% confidence interval: 1.19-11.43; P = 0.024). No statistically significant associations were observed with operative time, number of procedures, or comorbidities, although the limited number of events restricted interpretation of secondary variables. Transfused patients had significantly longer hospital stays. CONCLUSIONS: Postoperative transfusion in MWL body contouring was uncommon in this optimized single-center cohort but occurred predominantly in patients undergoing LBL procedures. These findings describe procedural patterns associated with transfusion burden in extensive circumferential procedures and may contribute to perioperative awareness and planning in MWL body contouring surgery.