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Valentine L, Alvarez AH, Weidman AA, Foppiani J, Hassell NE, Elmer N, Hwang P, Kaul S, Rosenblatt W, Lin SJ. Liposuction Complications in the Outpatient Setting: A National Analysis of 246,119 Cases in Accredited Ambulatory Surgery Facilities. Aesthet Surg J Open Forum 2023; 6:ojad107. [PMID: 38348141 PMCID: PMC10860384 DOI: 10.1093/asjof/ojad107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2024] Open
Abstract
Background Suction lipectomy (liposuction) is a popular cosmetic surgical procedure performed in the United States, but little has been documented regarding perioperative complications due to its outpatient nature. Objectives This cross-sectional study aims to analyze the most common complications that accompany liposuction-related procedures and importantly estimate the total complication rate occurring at ambulatory surgical facilities. Methods Adult patients who experienced liposuction-related complications from 2019 to 2021 were identified in the reporting database of the global surgery accreditation authority, the American Association for Accreditation of Ambulatory Surgery Facilities (QUAD A). Patients were then divided by complication type and procedure location. Demographics and facility-specific variables were analyzed. Descriptive statistics were performed. Results Overall, 984 patients were included, with a mean age of 44 years (interquartile range [IQR] 37-53) and a median BMI of 28.7 kg/m2 (IQR 25.7-32.2). The overall confirmed complication rate was found to be 0.40% (984/246,119). Unplanned emergency department presentation was the most common complication overall (24%). Wound disruption was associated with the longest median procedure length (261 min), and venous thromboembolism was associated with the highest median BMI (30.1 kg/m2). The Southeast had the most complications (431), which accounted for 13/21 deaths (61.9%). Out of all complications, death was associated with the highest average annual case volume (241). Conclusions Procedures that involve liposuction are associated with a variety of medical and surgical complications. Given the high frequency and variability in how liposuction is performed, a thorough assessment of complications is critical to improve the safety of this procedure. Level of Evidence 3
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Samuel J Lin
- Corresponding Author: Dr Samuel J. Lin, 110 Francis Street, Suite 5A, Boston, MA 02215, USA. E-mail: ; Instagram: @drsamuellin
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2
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Sergesketter AR, Shammas RL, Geng Y, Levinson H, Matros E, Phillips BT. Tracking Complications and Unplanned Healthcare Utilization in Aesthetic Surgery: An Analysis of 214,504 Patients Using the TOPS Database. Plast Reconstr Surg 2023; 151:1169-1178. [PMID: 36728533 PMCID: PMC10790563 DOI: 10.1097/prs.0000000000010148] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Tracking surgical complications and unplanned healthcare utilization is essential to inform quality initiatives in aesthetic surgery. This study used the Tracking Operations and Outcomes for Plastic Surgeons database to characterize rates and predictors of surgical complications and unplanned healthcare utilization across common aesthetic surgery procedures. METHODS The Tracking Operations and Outcomes for Plastic Surgeons database was queried for all patients undergoing breast augmentation, liposuction, blepharoplasty, rhinoplasty, and abdominoplasty from 2008 to 2019. Incidence and risk factors for complications and unplanned readmission, reoperation, and emergency room visits were determined. RESULTS A total of 214,504 patients were identified. Overall, 94,618 breast augmentations, 56,756 liposuction procedures, 29,797 blepharoplasties, 24,946 abdominoplasties, and 8387 rhinoplasties were included. A low incidence of perioperative complications was found, including seroma (1.1%), hematoma (0.7%), superficial wound complication (0.9%), deep surgical-site infection (0.2%), need for blood transfusion (0.05%), and deep venous thrombosis/pulmonary embolism (0.1%). Incidence of unplanned readmission, emergency room visits, and reoperation were 0.34%, 0.25%, and 0.80%, respectively. Patients who underwent an abdominoplasty more commonly presented to the emergency room and had unplanned readmissions or reoperations compared with other studied procedures. Furthermore, increased age, diabetes, higher body mass index, American Society of Anesthesiologists class, longer operative times, and pursuit of combined aesthetic procedures were associated with increased risk for unplanned health care use. CONCLUSIONS There is a low incidence of perioperative complications and unplanned healthcare utilization following common aesthetic surgery procedures. Continued entry into large national databases in aesthetic surgery is essential for internal benchmarking and quality improvement. CLINICAL QUESTION/LEVEL OF EVIDENCE Risk, III.
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Affiliation(s)
| | - Ronnie L. Shammas
- Division of Plastic, Oral, and Maxillofacial Surgery, Duke University, Durham, NC
| | | | - Howard Levinson
- Division of Plastic, Oral, and Maxillofacial Surgery, Duke University, Durham, NC
| | - Evan Matros
- Division of Plastic and Reconstructive Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Brett T. Phillips
- Division of Plastic, Oral, and Maxillofacial Surgery, Duke University, Durham, NC
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3
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Impact on Abdominal Skin Perfusion following Abdominoplasty. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2021; 9:e3343. [PMID: 33564578 PMCID: PMC7858225 DOI: 10.1097/gox.0000000000003343] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 11/11/2020] [Indexed: 11/25/2022]
Abstract
Wound healing problems following abdominoplasty may be a result of impaired tissue perfusion. This study evaluated the impact a standard abdominoplasty may have on abdominal skin perfusion.
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Unplanned 30-day readmission rates after plastic and reconstructive surgery procedures: a systematic review and meta-analysis. EUROPEAN JOURNAL OF PLASTIC SURGERY 2020. [DOI: 10.1007/s00238-020-01731-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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6
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Rosenfield LK, Davis CR. Evidence-Based Abdominoplasty Review With Body Contouring Algorithm. Aesthet Surg J 2019; 39:643-661. [PMID: 30649214 DOI: 10.1093/asj/sjz013] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Abdominal contour deformities are an aesthetic challenge to the plastic surgeon. Patients present with diverse clinical histories, multiple comorbidities, and unique aesthetic demands. Weight loss, previous pregnancy, and aging are 3 principal indications for abdominoplasty. Bariatric surgery has increased demand for body contouring procedures. This heterogeneous patient cohort means a "one-size-fits-all" abdominoplasty is not appropriate. Precise evaluation, evidence-based decision-making, and artistic acumen are required while balancing patient goals with safe, realistic, and long-lasting aesthetic outcomes. This article reviews surgical options for abdominal body contouring, providing an evidence-based treatment algorithm for selecting the appropriate procedure for each patient to maximize clinical and patient reported outcomes.
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Affiliation(s)
- Lorne K Rosenfield
- University of California, San Francisco, CA
- Stanford University, Stanford, CA
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8
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Augustine HFM, Hu J, Najarali Z, McRae M. Scoping Review of the National Surgical Quality Improvement Program in Plastic Surgery Research. Plast Surg (Oakv) 2019; 27:54-65. [PMID: 30854363 DOI: 10.1177/2292550318800499] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Background The National Surgical Quality Improvement Program (NSQIP) is a robust, high-quality surgical outcomes database that measures risk-adjusted 30-day outcomes of surgical interventions. The purpose of this scoping review is to describe how the NSQIP is being used in plastic surgery research. Methods A comprehensive electronic literature search was completed in PubMed, Embase, MEDLINE, and CINAHL. Two reviewers independently reviewed articles to determine their relevance using predefined inclusion criteria. Articles were included if they utilized NSQIP data to conduct research in a domain of plastic surgery or analyzed surgical procedures completed by plastic surgeons. Extracted information included the domain of plastic surgery, country of origin, journal, and year of publication. Results A total of 106 articles met the inclusion criteria. The most common domain of plastic surgery was breast reconstruction representing 35% of the articles. Of the 106 articles, 95% were published within the last 5 years. The Plastic and Reconstructive Surgery journal published most of the (59%) NSQIP-related articles. All of the studies were retrospective. Of note, there were no articles on burns and only one study on trauma as the domain of plastic surgery. Conclusion This scoping review describes how NSQIP data are being used to analyze plastic surgery interventions and outcomes in order to guide quality improvement in 106 articles. It demonstrates the utility of NSQIP in the literature, however also identifies some limitations of the program as it applies to plastic surgery.
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Affiliation(s)
- Haley F M Augustine
- Department of Plastic Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Jiayi Hu
- Department of Plastic Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Zainab Najarali
- Department of Family Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Matthew McRae
- Department of Plastic Surgery, McMaster University, Hamilton, Ontario, Canada
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9
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Discrepancies in the Definition of "Outpatient" Surgeries and Their Effect on Study Outcomes Related to ACDF and Lumbar Discectomy Procedures: A Retrospective Analysis of 45,204 Cases. Clin Spine Surg 2018; 31:E152-E159. [PMID: 29351096 DOI: 10.1097/bsd.0000000000000615] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
STUDY DESIGN This is a retrospective study. OBJECTIVE To study the differences in definition of "inpatient" and "outpatient" [stated status vs. actual length of stay (LOS)], and the effect of defining populations based on the different definitions, for anterior cervical discectomy and fusion (ACDF) and lumbar discectomy procedures in the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database. SUMMARY OF BACKGROUND DATA There has been an overall trend toward performing ACDF and lumbar discectomy in the outpatient setting. However, with the possibility of patients who underwent outpatient surgery staying overnight or longer at the hospital under "observation" status, the distinction of "inpatient" and "outpatient" is not clear. MATERIALS AND METHODS Patients who underwent ACDF or lumbar discectomy in the 2005-2014 ACS-NSQIP database were identified. Outpatient procedures were defined in 1 of 2 ways: either as being termed "outpatient" or hospital LOS=0. Differences in definitions were studied. Further, to evaluate the effect of the different definitions, 30-day outcomes were compared between "inpatient" and "outpatient" and between LOS>0 and LOS=0 for ACDF patients. RESULTS Of the 4123 "outpatient" ACDF patients, 919 had LOS=0, whereas 3204 had LOS>0. Of the 13,210 "inpatient" ACDF patients, 337 had LOS=0, whereas 12,873 had LOS>0. Of the 15,166 "outpatient" lumbar discectomy patients, 8968 had LOS=0, whereas 6198 had LOS>0. Of the 12,705 "inpatient" lumbar discectomy patients, 814 had LOS=0, whereas 11,891 had LOS>0. On multivariate analysis of ACDF patients, when comparing "inpatient" with "outpatient" and "LOS>0" with "LOS=0" there were differences in risks for adverse outcomes based on the definition of outpatient status. CONCLUSIONS When evaluating the ACS-NSQIP population, ACDF and lumbar discectomy procedures recorded as "outpatient" can be misleading and often did not correlate with same day discharge. These findings have significant impact on the interpretation of existing studies and define an area that needs clarification for future studies. LEVEL OF EVIDENCE Level 3.
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11
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Bovonratwet P, Webb ML, Ondeck NT, Lukasiewicz AM, Cui JJ, McLynn RP, Grauer JN. Definitional Differences of 'Outpatient' Versus 'Inpatient' THA and TKA Can Affect Study Outcomes. Clin Orthop Relat Res 2017; 475:2917-2925. [PMID: 28083753 PMCID: PMC5670045 DOI: 10.1007/s11999-017-5236-6] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND There has been great interest in performing outpatient THA and TKA. Studies have compared such procedures done as outpatients versus inpatients. However, stated "outpatient" status as defined by large national databases such as the National Surgical Quality Improvement Program (NSQIP) may not be a consistent entity, and the actual lengths of stay of those patients categorized as outpatients in NSQIP have not been specifically ascertained and may in fact include some patients who are "observed" for one or more nights. Current regulations in the United States allow these "observed" patients to stay more than one night at the hospital under observation status despite being coded as outpatients. Determining the degree to which this is the case, and what, exactly, "outpatient" means in the NSQIP, may influence the way clinicians read studies from that source and the way hospital systems and policymakers use those data. QUESTIONS/PURPOSES The purposes of this study were (1) to utilize the NSQIP database to characterize the differences in definition of "inpatient" and "outpatient" (stated status versus actual length of stay [LOS], measured in days) for THA and TKA; and (2) to study the effect of defining populations using different definitions. METHODS Patients who underwent THA and TKA in the 2005 to 2014 NSQIP database were identified. Outpatient procedures were defined as either hospital LOS = 0 days in NSQIP or being termed "outpatient" by the hospital. The actual hospital LOS of "outpatients" was characterized. "Outpatients" were considered to have stayed overnight if they had a LOS of 1 day or longer. The effects of the different definitions on 30-day outcomes were evaluated using multivariate analysis while controlling for potential confounding factors. RESULTS Of 72,651 patients undergoing THA, 529 were identified as "outpatients" but only 63 of these (12%) had a LOS = 0. Of 117,454 patients undergoing TKA, 890 were identified as "outpatients" but only 95 of these (11%) had a LOS = 0. After controlling for potential confounding factors such as gender, body mass index, functional status before surgery, comorbidities, and smoking status, we found "inpatient" THA to be associated with increased risk of any adverse event (relative risk, 2.643, p = 0.002), serious adverse event (relative risk, 2.455, p = 0.011), and readmission (relative risk, 2.775, p = 0.010) compared with "outpatient" THA. However, for the same procedure and controlling for the same factors, patients who had LOS > 0 were not associated with any increased risk compared with patients who had LOS = 0. A similar trend was also found in the TKA cohort. CONCLUSIONS Future THA, TKA, or other investigations on this topic should consistently quantify the term "outpatient" because different definitions, stated status or actual LOS, may lead to different assignments of risk factors for postoperative complications. Accurate data regarding risk factors for complications after total joint arthroplasty are crucial for efforts to reduce length of hospital stay and minimize complications. LEVEL OF EVIDENCE Level III, therapeutic study.
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Affiliation(s)
- Patawut Bovonratwet
- 0000000419368710grid.47100.32Department of Orthopaedics and Rehabilitation, Yale University School of Medicine, 47 College Street, New Haven, CT 06520 USA
| | - Matthew L. Webb
- 0000 0004 0435 0884grid.411115.1Department of Orthopaedic Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA USA
| | - Nathaniel T. Ondeck
- 0000000419368710grid.47100.32Department of Orthopaedics and Rehabilitation, Yale University School of Medicine, 47 College Street, New Haven, CT 06520 USA
| | - Adam M. Lukasiewicz
- 0000000419368710grid.47100.32Department of Orthopaedics and Rehabilitation, Yale University School of Medicine, 47 College Street, New Haven, CT 06520 USA
| | - Jonathan J. Cui
- 0000000419368710grid.47100.32Department of Orthopaedics and Rehabilitation, Yale University School of Medicine, 47 College Street, New Haven, CT 06520 USA
| | - Ryan P. McLynn
- 0000000419368710grid.47100.32Department of Orthopaedics and Rehabilitation, Yale University School of Medicine, 47 College Street, New Haven, CT 06520 USA
| | - Jonathan N. Grauer
- 0000000419368710grid.47100.32Department of Orthopaedics and Rehabilitation, Yale University School of Medicine, 47 College Street, New Haven, CT 06520 USA
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12
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LaBove G, Davison SP, Jackson M. Compliance of Perioperative Antibiotic Dosing and Surgical Site Infection Rate in Office-Based Elective Surgery. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2016; 4:e710. [PMID: 27579234 PMCID: PMC4995711 DOI: 10.1097/gox.0000000000000704] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Accepted: 03/09/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND A best practice goal to reduce surgical site infection includes administration of antibiotics in the ideal preoperative window. This article evaluates an office surgical suite antibiotic administration rate and compares it with the timing of a local hospital treating a similar patient population. The hypothesis was that similar or better compliance and surgical site infection rates can be achieved in the office-based suite. METHODS A total of 277 office-based surgeries were analyzed for antibiotic administration time before incision and their corresponding surgical site infection rate. RESULTS Our facility administered timely prophylactic antibiotics in 96% of cases with a surgical site infection rate of 0.36%. This rate was significantly lower than a reported rate of 3.7%. CONCLUSION Low infection rates with high antibiotic administration rate suggest that compliance with best possible practice protocols is possible in the outpatient setting.
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Affiliation(s)
- Gabrielle LaBove
- From the DAVinci Plastic Surgery, Wash.; DAVinci Plastic Surgery, Georgetown University School of Medicine, Wash.; and Department of Mathematics and Statistics, American University, Wash
| | - Steven P. Davison
- From the DAVinci Plastic Surgery, Wash.; DAVinci Plastic Surgery, Georgetown University School of Medicine, Wash.; and Department of Mathematics and Statistics, American University, Wash
| | - Monica Jackson
- From the DAVinci Plastic Surgery, Wash.; DAVinci Plastic Surgery, Georgetown University School of Medicine, Wash.; and Department of Mathematics and Statistics, American University, Wash
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Isedale G, Harris I, Rider M. Improving hand surgery access and care through service redesign. ANZ J Surg 2015; 86:581-3. [PMID: 26631355 DOI: 10.1111/ans.13395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/27/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND The hand surgery service in our major trauma centre comprised predominantly emergency surgery with poor theatre access, resulting in many cases being postponed and performed after hours and with low rates of supervision. METHOD We report the results of a before-and-after study describing the change in processes and outcomes associated with a change in the model of care to a sequestered, area-wide hand surgery service. The study uses data from 12 months prior to and 12 months after the change in practice. RESULTS The hand service experienced a 24.7% increase in demand for surgery in the first 12 months after the relocation. However, demand for overnight beds fell by 303%, the rate of specialist supervision increased from 23.5% to 81.3% (P < 0.0001), the time between admission and surgery fell from 5.1 to 2.7 h (P < 0.0001), the rate of cancellations fell from 21.8% to 7.7% (P < 0.0001), the proportion of emergency surgery conducted in normal hours increased from 65.8% to 93.6% (P < 0.0001), the 28-day unplanned reoperation rate fell from 1.2% to 0.5% (P = 0.02) and surgical time decreased to an equivalent of 41 half day operating sessions per year. CONCLUSION These outcomes are in line with international experiences of service centralization. The project may be used as a template for practice change in other surgical fields.
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Affiliation(s)
- Grant Isedale
- Critical Care & Surgical Specialties Clinical Stream, South Western Sydney Local Health District, Liverpool, New South Wales, Australia
| | - Ian Harris
- South Western Sydney Clinical School, University of New South Wales, Ingham Institute for Applied Medical Research, South Western Sydney Local Health District, Liverpool, New South Wales, Australia
| | - Mark Rider
- South Western Sydney Hand Centre, Fairfield Hospital, Prairiewood, New South Wales, Australia
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Khavanin N, Jordan SW, Vieira BL, Hume KM, Mlodinow AS, Simmons CJ, Murphy RX, Gutowski KA, Kim JYS. Combining abdominal and cosmetic breast surgery does not increase short-term complication rates: a comparison of each individual procedure and pretreatment risk stratification tool. Aesthet Surg J 2015; 35:999-1006. [PMID: 26163312 DOI: 10.1093/asj/sjv087] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/15/2015] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Combined abdominal and breast surgery presents a convenient and relatively cost-effective approach for accomplishing both procedures. OBJECTIVES This study is the largest to date assessing the safety of combined procedures, and it aims to develop a simple pretreatment risk stratification method for patients who desire a combined procedure. METHODS All women undergoing abdominoplasty, panniculectomy, augmentation mammaplasty, and/or mastopexy in the TOPS database were identified. Demographics and outcomes for combined procedures were compared to individual procedures using χ(2) and Student's t-tests. Multiple logistic regression provided adjusted odds ratios for the effect of a combined procedure on 30-day complications. Among combined procedures, a logistic regression model determined point values for pretreatment risk factors including diabetes (1 point), age over 53 (1), obesity (2), and 3+ ASA status (3), creating a 7-point pretreatment risk stratification tool. RESULTS A total of 58,756 cases met inclusion criteria. Complication rates among combined procedures (9.40%) were greater than those of aesthetic breast surgery (2.66%; P < .001) but did not significantly differ from abdominal procedures (9.75%; P = .530). Nearly 77% of combined cases were classified as low-risk (0 points total) with a 9.78% complication rates. Medium-risk patients (1 to 3 points) had a 16.63% complication rate, and high-risk (4 to 7 points) 38.46%. CONCLUSIONS Combining abdominal and breast procedures is safe in the majority of patients and does not increase 30-day complications rates. The risk stratification tool can continue to ensure favorable outcomes for patients who may desire a combined surgery. LEVEL OF EVIDENCE 4 Risk.
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Affiliation(s)
- Nima Khavanin
- Ms Khavanin and Mr Mlodinow are Medical Students, Dr Jordan is a Resident, Ms Vieira is a Clinical Researcher, and Dr Kim is an Attending Physician, Northwestern University, Feinberg School of Medicine, Chicago, Illinois. Mr Hume is the TOPS Registry Administrator and Mr Simmons is a TOPS Registry Clinical Research Associate, Arlington Heights, Illinois. Dr Murphy is an Attending Physician, Lehigh Valley Health Network, Allentown, Pennsylvania. Dr Gutowski is a plastic surgeon in private practice in Northbrook, Illinois
| | - Sumanas W Jordan
- Ms Khavanin and Mr Mlodinow are Medical Students, Dr Jordan is a Resident, Ms Vieira is a Clinical Researcher, and Dr Kim is an Attending Physician, Northwestern University, Feinberg School of Medicine, Chicago, Illinois. Mr Hume is the TOPS Registry Administrator and Mr Simmons is a TOPS Registry Clinical Research Associate, Arlington Heights, Illinois. Dr Murphy is an Attending Physician, Lehigh Valley Health Network, Allentown, Pennsylvania. Dr Gutowski is a plastic surgeon in private practice in Northbrook, Illinois
| | - Brittany L Vieira
- Ms Khavanin and Mr Mlodinow are Medical Students, Dr Jordan is a Resident, Ms Vieira is a Clinical Researcher, and Dr Kim is an Attending Physician, Northwestern University, Feinberg School of Medicine, Chicago, Illinois. Mr Hume is the TOPS Registry Administrator and Mr Simmons is a TOPS Registry Clinical Research Associate, Arlington Heights, Illinois. Dr Murphy is an Attending Physician, Lehigh Valley Health Network, Allentown, Pennsylvania. Dr Gutowski is a plastic surgeon in private practice in Northbrook, Illinois
| | - Keith M Hume
- Ms Khavanin and Mr Mlodinow are Medical Students, Dr Jordan is a Resident, Ms Vieira is a Clinical Researcher, and Dr Kim is an Attending Physician, Northwestern University, Feinberg School of Medicine, Chicago, Illinois. Mr Hume is the TOPS Registry Administrator and Mr Simmons is a TOPS Registry Clinical Research Associate, Arlington Heights, Illinois. Dr Murphy is an Attending Physician, Lehigh Valley Health Network, Allentown, Pennsylvania. Dr Gutowski is a plastic surgeon in private practice in Northbrook, Illinois
| | - Alexei S Mlodinow
- Ms Khavanin and Mr Mlodinow are Medical Students, Dr Jordan is a Resident, Ms Vieira is a Clinical Researcher, and Dr Kim is an Attending Physician, Northwestern University, Feinberg School of Medicine, Chicago, Illinois. Mr Hume is the TOPS Registry Administrator and Mr Simmons is a TOPS Registry Clinical Research Associate, Arlington Heights, Illinois. Dr Murphy is an Attending Physician, Lehigh Valley Health Network, Allentown, Pennsylvania. Dr Gutowski is a plastic surgeon in private practice in Northbrook, Illinois
| | - Christopher J Simmons
- Ms Khavanin and Mr Mlodinow are Medical Students, Dr Jordan is a Resident, Ms Vieira is a Clinical Researcher, and Dr Kim is an Attending Physician, Northwestern University, Feinberg School of Medicine, Chicago, Illinois. Mr Hume is the TOPS Registry Administrator and Mr Simmons is a TOPS Registry Clinical Research Associate, Arlington Heights, Illinois. Dr Murphy is an Attending Physician, Lehigh Valley Health Network, Allentown, Pennsylvania. Dr Gutowski is a plastic surgeon in private practice in Northbrook, Illinois
| | - Robert X Murphy
- Ms Khavanin and Mr Mlodinow are Medical Students, Dr Jordan is a Resident, Ms Vieira is a Clinical Researcher, and Dr Kim is an Attending Physician, Northwestern University, Feinberg School of Medicine, Chicago, Illinois. Mr Hume is the TOPS Registry Administrator and Mr Simmons is a TOPS Registry Clinical Research Associate, Arlington Heights, Illinois. Dr Murphy is an Attending Physician, Lehigh Valley Health Network, Allentown, Pennsylvania. Dr Gutowski is a plastic surgeon in private practice in Northbrook, Illinois
| | - Karol A Gutowski
- Ms Khavanin and Mr Mlodinow are Medical Students, Dr Jordan is a Resident, Ms Vieira is a Clinical Researcher, and Dr Kim is an Attending Physician, Northwestern University, Feinberg School of Medicine, Chicago, Illinois. Mr Hume is the TOPS Registry Administrator and Mr Simmons is a TOPS Registry Clinical Research Associate, Arlington Heights, Illinois. Dr Murphy is an Attending Physician, Lehigh Valley Health Network, Allentown, Pennsylvania. Dr Gutowski is a plastic surgeon in private practice in Northbrook, Illinois
| | - John Y S Kim
- Ms Khavanin and Mr Mlodinow are Medical Students, Dr Jordan is a Resident, Ms Vieira is a Clinical Researcher, and Dr Kim is an Attending Physician, Northwestern University, Feinberg School of Medicine, Chicago, Illinois. Mr Hume is the TOPS Registry Administrator and Mr Simmons is a TOPS Registry Clinical Research Associate, Arlington Heights, Illinois. Dr Murphy is an Attending Physician, Lehigh Valley Health Network, Allentown, Pennsylvania. Dr Gutowski is a plastic surgeon in private practice in Northbrook, Illinois
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15
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Quality and safety outcomes of ambulatory plastic surgery facilities in California. Plast Reconstr Surg 2015; 135:791-797. [PMID: 25719698 DOI: 10.1097/prs.0000000000001041] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Although most cosmetic surgery procedures are performed at outpatient surgery facilities, there is little published literature on the quality and safety of such facilities. Furthermore, regulation of such facilities varies widely and may leave room for poor outcomes. The authors sought to determine whether all outpatient surgery facilities that are licensed by the California Department of Public Health have similar rates of postoperative complications. METHODS A retrospective review was performed of all data collected from 2005 to 2010 by the California Office of Statewide Health Planning and Development. All outpatient surgery facilities licensed by the Department of Public Health must report encounter-level data to that office. Patients' subsequent inpatient admissions and emergency department visits were identified. Several cosmetic procedures were studied. Outcomes analyzed were the 30-day venous thromboembolism, hospital admission, and emergency department visit rates. RESULTS A total of 160,847 patients and 635 facilities were included. By facility, the range for 30-day venous thromboembolism rates was 0 to 3.4 percent, the range for 30-day admission rates was 0 to 7.7 percent, and the range for 30-day emergency department visits was 0 to 22.8 percent. CONCLUSIONS Analysis showed a significant variability in the rate of 30-day venous thromboembolism incidents, admissions, and emergency department visits. Some facilities had complication rates that were a significant deviation from the mean, whereas others had no complications. To ensure optimal quality and patient safety, it is necessary to analyze why outliers exist and identify ways to improve on the current system of licensure and outcomes reporting.
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Abstract
BACKGROUND The ability to study population-level outcomes of outpatient cosmetic procedures has been limited by a lack of longitudinal data. This study aimed to describe the rates of adverse events in patients who underwent an isolated cosmetic surgery procedure compared with those who had a combination of two procedures. METHODS Retrospective longitudinal analysis was performed of the 2005 to 2010 California Office of Statewide Health Planning and Development Ambulatory Surgery Database. Patients were included if they had undergone an abdominoplasty or any other procedure that was identified as frequently performed concurrently with abdominoplasty. Patients' subsequent in-patient admissions and emergency department visits were identified. Outcomes analyzed were the 30-day and 1-year venous thromboembolism rates, 30-day hospital admission rate, 30-day emergency department visit rate, and 30-day mortality rate. RESULTS A total of 477,741 patients were analyzed, of whom 16,893 had undergone two concurrent procedures. The 12-month venous thromboembolism rate was 0.57 percent for patients undergoing abdominoplasty, 0.20 percent for liposuction, 0.12 percent for breast procedures, 0.32 percent for hernia repair, 0.28 percent for face procedures, and 0.28 percent for thigh lift/brachioplasty. Greater than additive 30-day and 1-year venous thromboembolism rates were observed among patients who underwent an abdominoplasty and liposuction (0.68 percent and 0.81 percent, respectively) and those who underwent an abdominoplasty and hernia repair (0.93 percent). CONCLUSIONS Some combinations of elective outpatient procedures conferred an additive, and sometimes more than additive, venous thromboembolism risk. This is an important consideration when informing patients of potential postoperative complications and for venous thromboembolism prophylaxis.
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McGuire MF. Commentary on: A comparative analysis of readmission rates after outpatient cosmetic surgery. Aesthet Surg J 2014; 34:324-5. [PMID: 24497617 DOI: 10.1177/1090820x13519797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Michael F McGuire
- Dr McGuire is a Director of the American Board of Plastic Surgery, Clinical Professor in the Division of Plastic and Reconstructive Surgery, USC, Los Angeles, California, and Associate Clinical Professor in the Division of Plastic and Reconstructive Surgery, UCLA, Los Angeles, California
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