PURPOSE: In recent years, the demand for aesthetic surgery has increased with procedures like gluteal enhancement gaining popularity.1 Knowledge of adverse effects that may occur following these surgical interventions is critical in evaluating their associated risks and overall safety.2 Many patients undergo these procedures in outpatient settings and are later admitted on an emergent basis to the hospital with a variety of potentially life-threatening complications. This is often the result of inadequate postoperative monitoring or care.3 The goal of this study is to review the data on complications related to outpatient aesthetic surgical procedures in order to characterize the scope of the issue and generate recommendations for improved postoperative monitoring and care.
METHOD: A retrospective chart review from June 2021 to February 2022 of patients presenting to the emergency department following complications from outpatient aesthetic procedures. Variables collected include procedure type, time elapsed since surgical procedure, hospital length of stay, ICU length of stay, number of ventilator days, number of blood transfusions, number of operative interventions, mortality, diagnosis, complications, and discharge disposition.
RESULTS: A total of 37 patients met inclusion criteria. The age range of the patient population was 23 to 55 (average age 35). All patients were female. The average number of days since surgery was 4.5, (range: 0 to 35 days) and the average hospital length of stay was 4.7 (range: 0 to 9 days). Six patients were admitted to the ICU for an average of 2.17 days and no reported ventilator days. Nineteen patients received blood transfusions, averaging 1.89 units of blood. Three patients underwent operative interventions. Thirty-five patients were discharged home, of which one required home health services and one left against medical advice. Two patients were discharged to a rehabilitation center or acute care hospital. Liposuction and gluteal augmentation ‘Brazilian Butt Lift’ (BBL) had the highest rate of complications, accounting for 37.94% of procedures. This was followed by combined liposuction, abdominoplasty, and BBL (16.22%), liposuction (10.82%), abdominoplasty (8.12%), and combined liposuction, abdominoplasty, and breast augmentation (5.41%). Overall, the most common complication was anemia due to postoperative acute blood loss, occurring in 72.98% of patients as well as in all cosmetic procedures involving gluteal augmentation (BBL). This was followed by acute post-surgical pain (56.75%), syncope/near syncope episodes (35.14%), hypovolemia (35.14%), sepsis (18.92%), wound drainage (18.92%), infection (16.22%), cellulitis (13.51%), and wound dehiscence (10.81%). Less common complications include but are not limited to dyspnea, abnormal liver function, acute respiratory failure, and surgical site hematoma, each occurring in 5.41% of patients. Systemic complications were more common in procedures involving liposuction with and without combined BBL procedure.
CONCLUSION: These results bring into focus the potentially life-threatening complications that outpatient aesthetic surgery patients incur, with the highest rates of complications occurring in liposuction and BBL procedures. Examining common complications following these procedures can provide insight for healthcare providers and lead to the reduction of adverse outcomes. These findings also underscore the need for appropriate and necessary post-operative patient monitoring and follow-up care after ambulatory aesthetic surgery.
REFERENCES:
1. Senderoff DM. Aesthetic Surgery of the Buttocks Using Implants: Practice-Based Recommendations. Aesthet Surg J. 2016;36(5):559-576. doi:10.1093/asj/sjv251
2. Morzycki AD, Hudson AS, Samargandi OA, Bezuhly M, Williams JG. Reporting Adverse Events in Plastic Surgery: A Systematic Review of Randomized Controlled Trials. Plast Reconstr Surg. 2019;143(1):199e-208e. doi:10.1097/PRS.0000000000005101
3. Venditto C, Gallagher M, Hettinger P, et al. Complications of Cosmetic Surgery Tourism: Case Series and Cost Analysis. Aesthet Surg J. 2021;41(5):627-634. doi:10.1093/asj/sjaa092