Office-based Aesthetic Surgery Utilizing General Anesthesia: How Safe Is It? Analysis of 2579 Consecutive Cases In A Single Center
James Healy Healy, BA1, Marco A. Gonzalez, MD1, Mark M. Melendez,, MD, MBA1, Jonathan M. Tan, MD, MPH1, Alexander B. Dagum, MD1, Sumeet Teotia, MD2, Michael Beasley, MD3, Sami Khan, MD1.
1Stony Brook University Hospital, Stony Brook, NY, USA, 2Department of Plastic and Reconstructive Surgery, University of Texas-Southwestern, Dallas, TX, USA, 3Charlotte Plastic Surgery, Charlotte, Charlotte, NC, USA.
The last two decades have ushered in a dramatic change in the setting for most plastic surgery procedures, with a shift from hospital-based surgery towards operations in ambulatory or office-based settings. This shift has raised concern about safety and the incidence of complications in outpatient facilities. We performed a retrospective review of all procedures performed at a single office-based facility, performed between 2001 and 2004. Our objective was to quantify the incidence of major complications or mortality in order to evaluate the safety of office-based aesthetic surgery and to establish patient safety guidelines in these patients.
A retrospective chart review of prospectively collected data was performed on 2,579 consecutive patients, who underwent aesthetic procedures by a single group during a 4-year period. Charts were assessed for patient demographic information and post-operative complications that occurred in the PACU (Post-Anesthesia Care Unit). Statistical analysis was conducted using SAS software version 9.1.3 (SAS Institute Inc., Cary, NC, USA).
2,579 patient-visits of a total of 2,595 studied had complete data and were included in the study (99.4%). All patients who underwent aesthetic surgical procedures had Intravenous General Anesthesia (IVGA). The mean length of surgical procedure time was 104 minutes (Range 10-371 minutes, Std Dev 63.6 minutes). The mean length of anesthesia time was 126.6 minutes (Range 10-420 minutes, Std Dev 70.5 minutes). The mean American Society of Anesthesiologists (ASA) physical status classification system score for all patients was 1.4 (Range of 1-3). The most common post-operative complications included 63 post-operative nausea and vomiting events (2.43%), urinary retention in 17 cases (0.66%), need for admission in 1 event (0.04%), cardiac complications including bradycardia in 1 event (0.04%), hypotension in 1 event (0.04%), and ST changes in 1 event (0.04%), documented deep venous thrombosis (0.04%), and documented pulmonary embolism(0.04%). There were no deaths in our study population.
As the media and state regulatory boards continue to scrutinize office based surgery and establish arbitrary guidelines, it is important for plastic surgeons, as leaders in aesthetic surgery and advocates for our patients’ safety, to systematically analyze our clinical outcomes. This will allow us to establish evidence based guidelines to improve patient safety. Our results demonstrate a high safety profile for outpatient aesthetic procedures, consistent with those of prior studies.
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