Critical Appraisal: Anesthetic Management and Perioperative Predictors of Outcomes in Combined Body Contouring Procedures.

This letter discusses the paper authored by Sahin et al. titled "Anesthetic Management and Perioperative Risk Factors in Combined Body Contouring Procedures: Brazilian Butt Lift, Liposuction and Abdominoplasty." Notable strengths include the large cohort (n = 1120) and the standardized protocols, as well as the low complication rate (0.8%). Noteworthy weaknesses include methodological concerns, which limit the conclusions. The selection bias of the retrospective design and ASA I-II classification compared with data from national datasets reporting higher morbidity are limitations. Because of its multiplicity of predictors and the few number of events, there are concerns of overfitting in the multivariable model. There is also residual confounding between groups, and the binary "prior surgery" variable does not differentiate high-risk post-bariatric patients. There was no uniformity in outcomes reported, no follow-up, and no patient-reported outcomes. Claims that combined procedures seem safe should be cautious; findings are hypothesis generating. Future studies should focus on prospective multicenter study, bariatric surgery subgroups analysis, validated prediction modeling, and patient-centered outcomes.Level of Evidence V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .