Sunday, October 12
BACKGROUND: Correlated with the increasing utilization of bariatric surgery is an increasing demand for body contouring surgery.1 More than 330,000 body contouring procedures were performed in 2012. The purpose of this study is to evaluate the outcomes of body contouring procedures as they relate to provider specialty training (general surgeon versus plastic surgeon) as an independent predictor.
METHODS: The American College of Surgeons National Surgical Quality Improvement Program database was reviewed from 2005 to 2010 for all identifiable body contouring cases. Appropriate Current Procedural Terminology codes were used to identify body contouring procedures of the abdomen and breast, including suction assisted lipectomy. Pre-operative risk factors were identified and a multivariate analysis was used to investigate risk-adjusted outcomes, specialty comparisons, and predictors of morbidity.
RESULTS: A total of 2,632 patients were included. Most were women (n=2,317). The mean age was 47.4 years. Sixty eight point five (68.5) percent of the patients were white, 7.4 percent were African American and 8.78 percent were Hispanic. The abdominal contouring procedures were the most common making up 71.7 percent. One thousand eight hundred nine (68.5 percent) cases were done by plastic surgeons and 823 (31.2 percent) cases were done by general surgeons.Overall complications were reported in 236 (9.0 percent) patients, multivariate logistic regression revealed differing outcomes based on surgical specialty. Cases performed by general surgeons were associated with increased overall complication rates (OR 1.9, p=O.OO),wound infections (OR 1.9, p=O.OO), and returns to the operating room (OR 2.3, p=O.OO) when compared with the outcomes of plastic surgeons. Post-operative mean length of stay was significantly higher (OR 2.0, p=O.OO) for cases performed by general surgeons (2.3 days) compared to cases performed by plastic surgeons (0.73 days).
CONCLUSION: The apparent complication rate increase associated with general surgeons performing body contouring procedures suggests the need for specialized skill and training.2 Optimal execution of these burgeoning complex procedures, with lesser morbidity, seems to be a byproduct of the nation’s plastic surgery training programs. Additionally, the outcomes in this study might lend objectivity to contentious and unsettled debates, legislation3 and oversight regarding patient safety issues3-5 and “turf wars” (amongst specialty groups) as they pertain to these challenging aesthetic procedures.
2. Knox AD, Gilardino MS, Kasten SJ, Warren RJ, Anastakis DJ. Competency-medical education for plastic surgery: where do we begin? Plast Reconstr Surg. 2014;135:702e–710e
3. Ladocsi LT, Zinsser JW. The consequences of expanded oral surgery scope of practice in Richmond, Virginia. Plast Reconstr Surg. 2007;119:387–400
4. Kuczynski A, St. John W. Why did they die in cosmetic surgery? The New York Times. June 20, 2004
5. Murphy K. Ear doctors performing facelifts? It happens. The New York Times. January 30, 2012