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National Mortality Rates after Outpatient Cosmetic Surgery and Low Rates of Perioperative Deep Vein Thrombosis Screening and Prophylaxis

Bucknor, Alexandra M.B.B.S., M.Sc.; Egeler, Sabine A. M.D.; Chen, Austin D.; Chattha, Anmol B.A.; Kamali, Parisa M.D.; Brownstein, Gary M.D.; Reed, Lawrence M.D.; Watts, David M.D.; Lin, Samuel J. M.D., M.B.A.

Plastic and Reconstructive Surgery: July 2018 - Volume 142 - Issue 1 - p 90-98
doi: 10.1097/PRS.0000000000004499
Cosmetic: Special Topic
Patient Safety CME

Background: Concerns have arisen over reports of deaths occurring after certain outpatient plastic surgery procedures. Here, the authors present a national analysis, reporting on deaths occurring after outpatient cosmetic surgical procedures and venous thromboembolism screening.

Methods: A retrospective analysis of the American Association for Accreditation of Ambulatory Surgical Facilities database was performed for the years 2012 to 2017. The authors retrieved data for all deaths occurring in association with cosmetic plastic surgery procedures. Patient demographics, procedural data, venous thromboembolism risk factor assessment, and cause of death were analyzed. Deidentified medical records, including coroner’s reports, were reviewed where available.

Results: Data for 42 deaths were retrieved. Of these, 90.5 percent (n=38) were female, and 61.9 percent were Caucasian (n=26). Mean age was 51.6 years, while mean body mass index was 29.5 kg/m2. Overall, 54.8 percent of these deaths occurred after abdominoplasty: 42.9 percent in isolation, 9.5 percent in combination with breast surgery, and 2.4 percent with facial surgery. Of the causes of death, most (38.1 percent) were thromboembolic in origin. Notably, in 25 of 42 cases, venous thromboembolism risk factor assessment was incorrect or absent (59.5 percent).

Conclusions: Accreditation agencies provide transparency and insight into outpatient surgical mortality on a national scale. Results suggest that adoption of venous thromboembolism screening techniques may not be universal despite an existing large body of published evidence. Optimization of thromboembolism prevention pathways remains vital, and consideration of anticoagulation in those undergoing abdominoplasty may be important in lowering outpatient mortality.

Boston, Mass.; Gurnee, Ill.; and Nijmegen, The Netherlands

From the Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School; the American Association for Accreditation of Ambulatory Surgery Facilities; and the Department of Plastic, Reconstructive and Hand Surgery, Radboud University Nijmegen Medical Centre.

Received for publication September 14, 2017; accepted February 5, 2018.

Disclosure:Drs. Brownstein, Reid, and Watts are on the Executive Committee for the American Association for Accreditation of Ambulatory Surgery Facilities and receive an annual stipend. None of the remaining authors has a financial interest in any of the products, devices, or drugs mentioned in this article.

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Samuel J. Lin, M.D., M.B.A., 110 Francis Street, Suite 5A, Boston, Mass. 02215,, David Watts, M.D., American Association for Accreditation of Ambulatory Surgery Facilities, Gurnee, Ill. 60031,

Copyright © 2018 by the American Society of Plastic Surgeons