Cosmetic Surgery Disasters II

Florida is the only state in the nation that has required mandatory reporting of adverse events after an office procedure. This data is publicly available and has now been collected for seven years. The Agency for Health Care Administration cross checks these reports against malpractice filings and against patient complaints. Although the information represents only adverse events, and there is no estimate of the total number of procedures preformed, the data is nevertheless very interesting. It is also worth noting that this information only relates to procedures performed in offices. There is no information about the complications resulting from procedures performed in surgicenters.

Over the 7 year period there were 31 deaths and 143 procedure-related complications and hospital transfers. 58% of the deaths and 61% of the complications were related to cosmetic procedures. The most dangerous procedure appears to be liposuction, which resulted in 8 of the 31 deaths and 24 of the 143 complications. Some of these figures relate to liposuction performed along with another procedure, such as abdominoplasty. 7 of the liposuction deaths were associated with the use of general anesthesia, and one with intravenous sedation. None was associated with local anesthesia. All of the liposuction deaths occurred several hours to 9 days after the patient was discharged in good condition. When only cosmetic procedures are considered, liposuction under accounted for 44% of the deaths and 27% of the hospital transfers. It has been estimated that 1/3 of all liposuction is performed under local (tumescent) anesthesia, so the lack of problems associated with this technique is remarkable.
When looked at by specialty, plastic surgeons were associated with 48% of all deaths and 83% of all cosmetic surgery deaths. Over 90% of the physicians reporting were board certified, and almost 97% had hospital privileges. 46% of the offices reporting events were accredited facilities.
This data, which is presented in the March 2008 issue of Dermatologic Surgery, highlights the fact that general anesthesia adds a significant risk to liposuction surgery. For almost all procedures, except abdominoplasty, local anesthesia could be substituted with an almost certain increase in patient safety.

Gerald N. Bock MD
California Skin & Laser Center
Stockton & Lodi CA