Aesthetic Plast Surg. 2026 Jun 12. doi: 10.1007/s00266-026-06123-4. Online ahead of print.
ABSTRACT
This letter to the editor offers a constructive commentary on a recently published multivariate analysis of predictors of complications in abdominoplasty. The authors commend the original study for its rigorous surgical standardization, consecutive patient enrollment, and single‑surgeon design, and agree that high body mass index and active smoking are independent risk factors, while preservation of Scarpa’s fascia appears protective. However, three methodological limitations are identified. First, the sample size and number of events barely meet the minimum recommended events‑per‑variable ratio for multivariate regression. Second, treating seroma, necrosis, and dehiscence as independent outcomes ignores competing risks among these complications, which may bias risk estimates. Third, the single‑center, single‑surgeon design limits external validity, and the finding that diabetes is not a risk factor contradicts some existing literature. The letter suggests that future analyses adopt competing‑risk models and include multicenter external validation. It also notes that no new patient data are provided, so the proposed statistical refinements await empirical verification.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 .
PMID:42286329 | DOI:10.1007/s00266-026-06123-4
