Study Supports Safety of Outpatient Plastic Surgery Procedures

A study including over 20 years of data and more 26,000 cases supports the safety of outpatient plastic surgery procedures—performed by qualified plastic surgeons, at an accredited outpatient surgical center, reports the April issue of Plastic and Reconstructive Surgery®, the official medical journal of the American Society of Plastic Surgeons (ASPS).

"We conclude that for a majority of patients, the overall risk is very low for performing plastic surgery in the outpatient setting," write Rod J. Rohrich, MD, and colleagues from the Dallas Plastic Surgery Institute. "However, certain precautions should be considered to optimize safety of all patients and reduce adverse outcomes." Dr. Rohrich is Editor-in-Chief of Plastic and Reconstructive Surgery®.

Low Complication Rate after Outpatient Plastic Surgery

The researchers analyzed 26,302 consecutive outpatient plastic surgery procedures performed between 1995 and 2017. All procedures were performed by board-certified plastic surgeons, at the authors' accredited outpatient surgical facility.

Breast surgeries such as breast augmentation were the most common type of procedure, followed by facial cosmetic surgery and liposuction. The researchers analyzed the rates and types of complications, including factors associated with an increased risk of complications. The study focused on complications occurring within the first 48 hours after surgery.

Overall, some type of complication occurred in just under one percent of patients (0.98 percent). This included 203 complications requiring a return to the operating room (OR), a rate of 0.78 percent. More than 80 percent of complications requiring return to the OR were hematoma: a collection of blood under the skin.

Less-common complications included infections, occurring at a rate of 0.06 percent; and blood clot-related complications, 0.05 percent. Two patients died: one of cardiac arrest and one with a blood clot-related complication. Both patients underwent combined procedures and were being monitored in hotel suites at the surgical center when the complications were first detected.

Patients undergoing combined procedures were at higher risk of complications. Other risk factors were higher body mass index, larger volumes of liposuction, and longer surgical times. Based on their experience, Dr. Rohrich and colleagues recommend postoperative monitoring in a nursing facility—surgical center or hospital—for obese patients (body mass index 30 or higher); surgeries lasting more than four hours; very large liposuction volumes (more than three liters); or combined procedures, especially abdominoplasty with liposuction.

In 2015, more than 90 percent of cosmetic plastic surgery procedures were performed on an outpatient basis, either a freestanding surgical center or office setting. The new study provides needed data on the safety of outpatient cosmetic surgery, when performed by Board-certified plastic surgeons in a surgical center with appropriate staffing and patient monitoring capability.

"Plastic surgery is safe to perform in an accredited outpatient facility for a majority of patients," Dr. Rohrich and colleagues write. Their experience updates a 2003 report, also published in Plastic and Reconstructive Surgery, which outlined a model for optimal patient safety.

Dr. Rohrich adds, "Our study provides evidence-based recommendations for patient safety in the outpatient plastic surgery setting, as well as recommendations to limit postoperative complications and hospital admission rates."

Plastic and Reconstructive Surgery® is published by Wolters Kluwer.

Click here to read "An Update on the Safety and Efficacy of Outpatient Plastic Surgery: A Review of 26,032 Consecutive Cases"

Article: "An Update on the Safety and Efficacy of Outpatient Plastic Surgery: A Review of 26,032 Consecutive Cases" (doi: 10.1097/PRS.0000000000004213)