Developing the Aesthetic Postoperative Complication Score (APeCS) for Detecting Major Morbidity in Facial Aesthetic Surgery

Abstract

Abstract 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 utilized to create the score. Performance robustness was measured with area under receiver operating characteristic curves and sensitivity analyses. 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 3 concomitant surgeries, BMI ≥25, ASA class ≥2, current or former smoker status, and age ≥45 as the variables fit for risk prediction (n = 13,004; area under curve: 0.68, standard error: 0.013, [0.62-0.67]). Each of the 5 variables counted for 1 point, except over 3 concomitant surgeries counting for 2, giving a score range from 0 to 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 having 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. Level of Evidence: 3