Position of the ASAPS
New York, NY (February 13, 2004) – The American Society for Aesthetic Plastic Surgery (ASAPS) supports the Florida Board of Medicine’s investigation into a small but significant number of patient deaths associated with surgical procedures, including plastic surgery, performed in office-based surgical facilities. However, ASAPS believes that the Board’s recent vote to enact a 90-day moratorium on the combination of liposuction and abdominoplasty (tummy tuck) in office-based facilities may not address the root causes of the problem.
“As the leading organization of board-certified plastic surgeons who specialize in cosmetic plastic surgery, ASAPS is committed to patient safety,” says plastic surgeon and ASAPS President Robert Bernard, MD. “There is no question that we support the continued study of the safety of office-based procedures.”
Dr. Bernard says he understands the Florida Board’s desire to act quickly and decisively and therefore hopes the 90-day ban will provide a cooling off period, during which time all members of the Florida medical community can be involved in proposing meaningful policies to provide the highest levels of patient safety. “Our concern is that it is easy to jump to a conclusion based on limited information. We want the Board to do its due diligence before enacting far-reaching restrictions impacting patient care.”
Data on patient mortality must always be examined in the context of the total number of procedures performed and expected risks. Dr. Bernard says that it has not yet been determined whether the problems experienced in Florida are related to particular types of procedures or to other factors. “Past history has shown that often the problem is the lack of appropriate patient selection, facility standards or physician training,” says Dr. Bernard. ASAPS has participated in development of recommended guidelines for office-based surgery, and has long been on record supporting mandatory facility accreditation. It enforces a policy that requires its own members to operate only in accredited, state-licensed or Medicare-certified surgical facilities.
According to ASAPS statistics, more than 83,000 Americans had tummy tucks and nearly 373,000 underwent liposuction (also called lipoplasty) in 2002. Results of a survey on lipoplasty safety ( Aesthetic Surgery Journal , 2001) covered 94,000 lipoplasty procedures performed by board-certified plastic surgeons. Results showed that the estimated risk of death from lipoplasty performed as an isolated procedure was 1 per 47,415 procedures. When combined with abdominoplasty, the risk was significantly higher – 1 per 3281. (For comparison, the risk of death from elective bariatric surgery is reported to be 48 in 3073 [ Surg Endosc . 2003].) However, the extent of lipoplasty performed or other factors contributing to increased risk of lipoplasty/abdominoplasty combinations could not be determined by the survey data, leaving these questions unanswered.
“More research on this issue is needed,” acknowledges Dr. Bernard. He contends, however, that a small amount of liposuction performed in conjunction with an abdominoplasty should not significantly increase risks. “The distinction should be made between very limited fat removal, done as part of the tummy tuck operation itself, and the combination of abdominoplasty with more extensive liposuction often involving other areas of the body.”
Safety of Office – Based Surgery
The safety of office-based surgery in accredited facilities is well established:
- A recent study analyzed over 400,000 procedures performed by board-certified surgeons in accredited outpatient facilities. Researchers conclude that their data document the safety for procedures performed by board-certified surgeons who have credentials to perform the same procedures in both a hospital and an accredited outpatient setting. The incidence of patient deaths after outpatient procedures was 0.002% or 1 in 51,459. [Note: The study was conducted by the American Association for Accreditation of Ambulatory Surgery Facilities (AAAASF) and is pending publication in a nationally recognized, peer-reviewed medical journal.]
- A review of 3,615 consecutive patients undergoing 4,778 outpatient plastic surgery procedures performed by multiple surgeons under monitored anesthesia care/sedation in a single office-based facility between May of 1995 and May of 2000 reported no deaths or life-threatening complications. ( Plast Reconstr. Surg. 111: 150, 2003).
- Peer-reviewed, published data on plastic surgery performed in accredited office-based facilities showed a complication rate of less than half of one percent in over 400,000 procedures. ( Plast. Reconstr. Surg . 99: 1496, 1997).
- A report on more than 23,000 consecutive office-based procedures under general anesthesia showed no significant anesthetic complications. ( Plast. Reconstr. Surg . 107: 243, 2001).
- According to statistics from the American Society for Aesthetic Plastic Surgery (ASAPS), in 2002, 45% of all cosmetic procedures were performed in office-based surgical facilities. Office-based surgery provides a safe, convenient and cost-effective alternative for many patients. Most insurance companies accept accredited office-based facilities as equivalent to hospitals for reimbursement of covered procedures, recognizing their proven safety and cost effectiveness.
- Members of the American Society for Aesthetic Plastic Surgery (ASAPS) operate only in accredited , state-licensed or Medicare-certified office-based facilities, surgicenters, and hospitals. ASAPS members are board-certified plastic surgeons who specialize in cosmetic surgery of the face and body.