Combination cosmetic surgery and general anesthesia risks

I have been a strong advocate of avoiding general anesthesia where possible and limiting combination cosmetic surgery procedures for patient safety. A recent study helps to hit some of these issues home.

A study published in Dermatologic Surgery looked at the rates of severe complications in office-based surgery in the states of Alabama and Florida over 6-10 years. This study looked at all specialties, not just cosmetic or plastic surgery.

In 10 years in Florida there were 46 deaths and 263 complications and hospital transfers reported. 2/3 of the deaths and 3/4 of the hospital transfers were from patients who had general anesthesia. In Alabama there were 3 deaths and 46 complications and hospital transfers, 86% of which were from patients who had general anesthesia. This is despite the fact that a minority of office based procedures are done under general anesthesia.

The study was particularly critical of liposuction under general anesthesia. In this study, liposuction under general anesthesia was associated with 1/3 of all cosmetic surgery deaths. The most common cause of death being pulmonary complications, particularly pulmonary embolism. There were no deaths from liposuction with local anesthesia.

The study also highlighted the issue of combination cosmetic surgeries. The rates of severe complications from these combinations has been proven to be much higher. This is particularly true of abdominoplasty with significant liposuction.

My feeling is that cosmetic surgery should be held at a higher level of safety than any other kind of surgery. We are not treating life threatening conditions. Every attempt should be made to reduce risks. Avoiding general anesthesia, where able, and limiting combination surgery are probably the most important steps that can be taken for patient safety.

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