ROLLING MEADOWS, Ill., March 30 /PRNewswire/ -- A review of surgeries performed in doctors' offices found that death or injury is more likely due to the use of general anesthesia in the office setting than to the medical procedure per se, according to dermasurgeon Brett Coldiron, M.D., author of two peer-reviewed articles on the safety of office-based surgery. A medical safety expert on anesthesia-related standards for surgery, Dr. Coldiron based his conclusions on a prospective study of incident reports over a three-year period from 2000-2003 filed with the Florida Agency for Health Care Administration. Florida is one of the few states that has high quality, mandatory reporting of deaths and injuries related to office surgeries.
These findings and the recent reports of deaths in New York City allegedly associated with cosmetic surgery done under general anesthesia have prompted the American Society for Dermatologic Surgery (ASDS) to encourage patients to opt for procedures that can be performed using local anesthesia in order to avoid the potential risks of general anesthesia. Further, the Society warns against extensive and complex cosmetic surgery involving multiple procedures at a single time.
"Our goal is to determine and analyze the nature of office procedure adverse incidents so we can better understand the risk factors and increase patient safety for cosmetic procedures," says Dr. Coldiron, clinical assistant professor, department of dermatology and otolaryngology, University of Cincinnati College of Medicine. "The Florida data clearly indicates that the greatest danger to patients lies not with the cosmetic or medically-necessary procedure per se, but rather with the use of general anesthesia in an office setting."
The report, to be published this summer in The Archives of Dermatology, details 13 procedure-related deaths and 43 procedure-related complications that resulted in a hospital transfer. Seven of the 13 deaths involved elective cosmetic procedures, five of which were performed under general anesthesia and two of which were performed using intravenous sedation anesthesia. Of the 43 complications, 13 transfers followed liposuction, abdominoplasty or both. Seven followed breast augmentation; six after face/brow/neck lifts; four after pregnancy terminations; four following endoscopies; three after skin cancer excisions; and two following oocyte retrievals. One hospital transfer is accounted to each of the following procedures: circumcision, cystoscopy, hemorrhoid ligation and vasectomy reversal.
With respect to liposuction, the researchers found that all the liposuction deaths and injuries in Florida were associated with liposuction performed under general anesthesia or deep sedation. In contrast, there were no deaths or injuries associated with liposuction using high volume, dilute local anesthesia (referred to as tumescent liposuction).
"The distinction between tumescent liposuction and fat removal operations using higher levels of anesthesia is an important distinction," says Dr. Coldiron. "In general, the Florida data is reassuring because there were no anesthesia-related deaths associated with office procedures using high volume, dilute local tumescent anesthesia, local anesthesia, regional block anesthesia, intramuscular analgesia and sedation, and conscious sedation. Moreover, it appears that the Florida Medical Board's restriction on multiple procedures under intravenous sedation or general anesthesia seems to have had a positive effect."
According to ASDS President, Ronald L. Moy, M.D., "The Society is committed to the highest standard of patient safety in surgery. However, restrictions on office procedures based on requirements for office accreditation, board certification or hospital privileges do not appear to be related to significantly fewer adverse incidents. Rather, we believe guidelines on the use of general anesthesia for office-based cosmetic surgeries deserve closer scrutiny and rational policy in this area will ultimately have a beneficial impact on patient safety."
With nearly 4,000 members, the American Society for Dermatologic Surgery, founded in 1970, is the largest specialty organization in the world exclusively representing dermasurgeons, board-certified physicians who are specifically trained to treat the health, function and appearance of the skin and soft tissue, with both medically necessary and cosmetic procedures, using both surgical and non-surgical methods. For more information on cosmetic skin procedures and referrals to board-certified dermasurgeons, please contact the ASDS Consumer Hotline, 1-800-441-ASDS (2737), during weekday business hours or log on at http://www.aboutskinsurgery.org/ .
For charts, go to the ASDS web site at http://www.aboutskinsurgery.org/ , and check out the media newsroom.
American Society for Dermatologic Surgery