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An Update on the Safety and Efficacy of Outpatient Plastic Surgery: A Review of 26,032 Consecutive Cases

Rohrich, Rod J., M.D.; Mendez, Bernardino M., M.D.; Afrooz, Paul N., M.D.

Plastic and Reconstructive Surgery: April 2018 - Volume 141 - Issue 4 - p 902-908
doi: 10.1097/PRS.0000000000004213
Cosmetic: Original Articles
Patient Safety CME
Press Release

Background: Outpatient surgery offers many advantages, including cost-containment, privacy, and convenience. However, patient safety must take precedence over these benefits. Limited well-designed studies exist in the plastic surgery literature on patient safety in the outpatient setting, particularly those that identify risk factors for adverse outcomes.

Methods: A retrospective review was performed on 26,032 consecutive cases completed by board-certified plastic surgeons at an accredited outpatient surgical center between 1995 and 2017. All cases were reviewed for potential morbidity and mortality events, and variables were analyzed to determine potential risk factors for postoperative complications and inpatient admission.

Results: A total of 26,032 cases were performed over a 23-year period. There were a total of 203 complications (0.78 percent). Compared with the control population, the 12 patients (0.05 percent) that sustained venous thromboembolic events demonstrated higher body mass indexes (p < 0.01), greater lipoaspirate amounts (p = 0.04), longer operative times (p < 0.01), and were more likely to have undergone a combined procedure (p < 0.01). In addition, the 22 patients (0.08 percent) that were transferred to inpatient facilities demonstrated greater body mass index (p < 0.01) and longer operative times (p = 0.01).

Conclusions: Plastic surgery is safe to perform in an accredited outpatient facility for a majority of patients. According to the authors’ data, postoperative monitoring in a nursing facility should be considered for the following high-risk patients: those with a body mass index greater than 30 kg/m2, operative times greater than 4 hours, lipoaspirate volumes greater than 3 liters, and those undergoing combined procedures.


Dallas, Texas

From the Dallas Plastic Surgery Institute and the Department of Plastic Surgery, University of Texas Southwestern Medical Center.

Received for publication May 22, 2017; accepted September 1, 2017.

Disclosure:Dr. Rohrich receives instrument royalties from Eriem Surgical, Inc., and book royalties from Thieme Medical Publishing. No funding was received for this article. The authors have no financial disclosures relevant to this study.

By reading this article, you are entitled to claim one (1) hour of Category 2 Patient Safety Credit. ASPS members can claim this credit by logging in to Dashboard, clicking “Submit CME,” and completing the form.

Rod J. Rohrich, M.D., Dallas Plastic Surgery Institute, 9101 North Central Expressway, Suite 600, Dallas, Texas 75231,, Twitter: @DrRodRohrich, Instagram: @Rod.Rohrich

Copyright © 2018 by the American Society of Plastic Surgeons