ARLINGTON HEIGHTS, Ill. - The first of four "practice advisories" to assist decision-making in areas of patient care for plastic surgery in the office setting was published in Plastic and Reconstructive Surgery®, the official medical journal of the American Society of Plastic Surgeons (ASPS). The advisory, by Ronald Iverson, MD, and the ASPS Task Force on Patient Safety in Office-based Surgery Facilities, looked into a variety of issues common to most plastic surgery procedures, but which vary depending on the procedure. The factors explored include: hypothermia, intraoperative blood loss, liposuction with multiple procedures, procedure duration, blood clots, postoperative recovery, physician qualifications and surgical facility standards.
"As more complex plastic surgery procedures are performed in the office setting, surgeons must put a variety of measures in place to ensure patient safety," said Dr. Iverson. "By implementing reasonable controls, office-based surgery can be a safe and positive experience for both the patient and the physician."
According to ASPS, 51 percent of all cosmetic plastic surgery was performed in office-based surgery facilities in 2001.
"After an extensive review of all existing guidelines, legislation and scientific literature, it was clear that few materials met the scientific rigor necessary to establish clear practice guidelines for plastic surgery procedures performed in office-based facilities," said Dr. Iverson. "The advisory represents the most comprehensive, current information available on practice principals for office-based surgery and will help to establish national standards on patient care and safety."
Patient Advisory Recommendations:
Hypothermia - Hypothermia (low body temperature) can develop because of a cold operating room as well as anesthesia's negative effect on the body's ability to regulate temperature . To prevent the condition, temperatures in the office operating room must be adequately monitored and adjustable. The surgery suite should be equipped with warming blankets and intravenous fluid warmers to keep the patient warm. Without these measures, procedures performed should be less than two hours and limited to no more than 20 percent of the body surface area.
Blood Loss - Significant blood loss can lead to an unstable condition during and after the procedure for the patient. Procedures on an average-size adult patient where 500 cc (about a pint) or greater anticipated blood loss is expected should be performed only in facilities where adequate blood products are readily available.
Liposuction with Multiple Procedures Concurrently - The benefits of combining cosmetic procedures, particularly liposuction, must be weighed against the possibility of complications. The removal of fat and liquid should be limited to 5000 cc or less. Large-volume liposuction, in combination with certain other procedures such as tummy tucks where serious complications can arise, should be avoided.
Procedure Duration - Most plastic surgery procedures including facelifts, nose reshapings, breast reductions, liposuction and tummy tucks typically take longer than an hour to complete. Lengthy procedures should be scheduled early in the day, if possible to be completed by 3 p.m. to allow adequate time for patient recovery and discharge. Ideally, the duration of the procedure(s) should be completed within six hours.
Blood Clots - The development of blood clots (deep vein thrombosis leading to pulmonary embolus) remains a small but significant risk for surgical patients. As part of the patient history and physical exam, attention should be paid to factors that predispose the patient to thrombosis or embolism, including the use of contraceptives and hormone replacement; family history with attention to past episodes of thrombosis or embolism; genetic disposition to clotting disorders, swelling or other signs of poor circulation in the legs. Next, the patient should be assigned a risk status of low, moderate, or high and necessary measures should be established for each status.
Postoperative Recovery Problems - Unplanned hospital admission following office-based plastic surgery results primarily from dizziness, pain and nausea/vomiting. Control of nausea/vomiting, dizziness and pain is essential to timely postoperative recovery and discharge. Pain management should be based on body mass index and the procedure performed. Additionally, the patient should be sent home with sufficient pain medication and adequate instructions for its use.
Provider Qualifications - Regardless of the location of the surgical facility, the physician should have hospital privileges for the procedure being performed and be qualified for examination by or be board-certified in a surgical specialty recognized by The American Board of Medical Specialties, such as The American Board of Plastic Surgery (ABPS).
Surgical Facility Standards - Plastic surgery performed under anesthesia, other than minor local anesthesia and/or minimal oral tranquilization, should be performed in a facility that meets at least one of the following criteria: Accredited by a national or state-recognized accrediting agency/organization such as the American Association for Accreditation of Ambulatory Surgery Facilities (AAAASF), the Accreditation Association for Ambulatory Health Care (AAAHC), or the Joint Commission on Accreditation of Healthcare Organizations (JCAHO); Certified to participate in the Medicare program under Title XVIII; Licensed by the state in which the facility operates.
All ASPS members who perform plastic surgery in offices where patients are under anesthesia were required to have their offices accredited by July 1, 2002 to promote patient safety in the office-based setting. By choosing an ASPS member plastic surgeon certified by the ABPS, patients are assured that the physician has graduated from an accredited medical school and completed at least five years of additional residency, usually three years of general surgery and two years of plastic surgery.
Print this page