Determining the Safety of Office-Based Surgery
Determining the Safety of Office-Based Surgery: What 10 Years of Florida Data and 6 Years of Alabama Data Reveal
Starling J, Thosani MK, Coldiron BM. Dermatologic Surgery. 2012;38:171-177.
When fatal complications related to cosmetic surgical procedures go up, the government cracks down. Based on both Florida and Alabama MD-required adverse event (AE) reporting to a central agency for patients undergoing office-based surgery, this study gathered and assessed complications for 10 years of data in Florida and 6 years in Alabama. Study researchers conducted a detailed investigation of physicians who had patient AEs that resulted in death or hospital transfers to determine their board certification, hospital privilege and office accreditation status.
In Florida, they found 46 deaths, more than half (56.5%) of which were a result of cosmetic procedures that were not medically necessary. Of the 263 AEs / hospital transfers, nearly half (49.8%) were also related to cosmetic procedures that were not medically necessary. Most of these AEs (67% and 74%, respectively) resulted from patients with procedures performed under general anesthesia. Ten deaths and 34 hospital transfers were related to liposuction with or without another cosmetic procedure. The majority (93%) of MDs reporting patient AEs were board certified, 38% were accredited, and almost all (98%) had hospital privileges. Nearly half (45%) of all reported AEs were made by plastic surgeons while dermatologists accounted for only 1.3%, with no reported deaths.
In Alabama, researchers found a total of 3 deaths, none of which were related to cosmetic procedures. Of the 49 reported AEs, 42% were related to cosmetic procedures; 86% of hospital transfers in this group were for patients under general anesthesia. No deaths and 2 hospital transfers were related to liposuction specifically. All (100%) MDs were board certified and 71% of their offices were accredited. Nearly half (42.3%) of all reported AEs were made by plastic surgeons while dermatologists accounted for only 1.9%, with no reported deaths. Researchers conclude that AE data in both Florida and Alabama are comparable / consistent, with medically necessary in-office surgery relatively safe. Cosmetic or not, in-office surgical procedures performed by dermatologists have a low AE rate, but nearly half are related to procedures performed by plastic surgeons. Board certification and hospital privileges do not appear to be related factors. Further research is needed to understand liposuction-related deaths performed under local anesthesia.
Publication available in Wiley’s Online Library at: http://onlinelibrary.wiley.com/doi/10.1111/j.1524-4725.2011.02206.x/abstract