Research Finds All Settings for Accredited Aesthetic Surgery are Safe
Data also show uptick in ASC surgeries
EXECUTIVE SUMMARY
Research shows that aesthetic surgery conducted by accredited sites results in very few complications, regardless of whether surgery is performed in an office-based site, an ASC, or a hospital-based surgery site.
- Complication rates for office-based surgery centers was 1.3%.
- Complication rates for ASCs was 1.9%.
- Complication rates for hospital-based surgery centers was 2.4%.
A new study shows that patients experienced very few complications post-aesthetic surgery, regardless of whether the surgery was performed in an office, at an ASC, or in a hospital. The data were collected only from accredited surgery sites.1
The study showed that complication rates in office-based surgery centers was 1.3% vs. 1.9% in ASCs and 2.4% in hospital-based surgery centers.1
“The data suggest there is a difference between settings,” says Kent K. Higdon, MD, FACS, associate program director and assistant professor in the department of plastic surgery at Vanderbilt University Medical Center in Nashville, TN.
The findings likely do not suggest a causal relationship in which office-based surgery is safer, but perhaps suggest that surgeons are doing a good job of sending patients to the surgery setting that would work best for them. So the patients with comorbid conditions might be scheduled for surgery in a hospital-based setting because their surgery could have a higher risk of complications, Higdon explains.
For patients with less risk of complications, an ASC is a more economical choice, as is the office-based surgery, he adds.
The study’s findings were not a surprise, Higdon notes.
“We expected the data would demonstrate there were low complication rates, and this paper confirms this,” he says. “We expected to find that the top two complications were hematoma and infection.”
The study was particularly interesting because it involved only accredited surgery sites, and it compared board-certified plastic surgeons performing the same procedures, says Hector Vila, Jr., MD, an anesthesiologist in Tampa, FL. Vila’s commentary about the study also was published.1
“The reason I wrote an editorial is because I did an article in 2003, showing that office surgeries were 10 times riskier,” Vila says. “The offices in the study I did were not accredited, so one of the main points in my editorial was that if it’s an accredited office, it basically is no different than a hospital or surgery center — it doesn’t matter where you do the surgery.”
It’s the accreditation that matters to ensure safety, he adds.
“There’s a potential of it being even safer in the office, and maybe that’s because in the office, there’s less chance of infection spreading, but we can’t say for sure,” Vila says.
Studies like Higdon’s are important to add to the collection of evidence that informs standards and policies. “We need evidence-based standards,” Vila says. “If you can’t prove it helps patients, then you shouldn’t be required to do it because it makes things more expensive, and we’re in a healthcare funding crisis.”
For two decades, plastic surgeons have been moving away from hospital settings to performing surgeries in ASCs or office-based centers, where the same surgeries can be performed for less money. The study found that between May 2008 and April 2013, hospital-based surgeries decreased from about 29% to 23%. In the same time period, office surgeries remained steady at 16%, and the percentage of surgeries performed in ASCs grew from about 54% to nearly 60%.1
“The cost of surgery in hospitals has increased over time,” Higdon notes. “Patients can receive the same high level of care in an ambulatory surgery center, which is more cost-effective, and it makes sense as people increasingly seek cosmetic surgery.”
The Workers Compensation Research Institute (WCRI) in 2014 conducted a study, titled “Comparing Payments to Ambulatory Surgery Centers and Hospital Outpatient Departments,” that found that payments for common workers’ compensation surgeries conducted at ASCs were less expensive than hospital outpatient surgeries, although there are some exceptions. (More information on the study can be found at: http://bit.ly/2lSTACE.)
The question the study authors sought to answer was whether this shift away from hospitals resulted in more surgical complications and infections.
Using very robust data, researchers wanted to conduct a prospective data study that compared surgeries and surgery-related problems across settings. “Nobody has done this research to this point, except for smaller studies with limitations,” Higdon says.
The prospective data used in the study included information about 183,914 procedures for 129,007 patients. It was gathered from a database from CosmetAssure, a company that provides insurance to cover aesthetic surgical complications.1
The database includes only board-certified surgeons eligible for CosmetAssure membership. Candidates for membership must pass a written test and have high technical and ethical skills, Higdon says.
CosmetAssure provides insurance to patients to cover aesthetic surgical complications that might not be covered by standard insurance and might otherwise require the patient to pay out of pocket. Patients pay a small premium for the mandatory coverage at many aesthetic surgery centers.
The database is huge and has been cross-validated by other organizations, including Tracking Operations and Outcomes for Plastic Surgeons (TOPS).
“Cosmetic surgery routinely is not covered by insurance, so this is a different cohort than other ambulatory surgery data, such as ENT and orthopedic,” Higdon says.
Higdon and co-investigators reviewed the data for differences between patients treated in office-based, ASC, and hospital-based settings. They found that the top two surgeries for both office and ASC settings were breast augmentation and liposuction; for hospital-based surgery centers, the top two were breast augmentation and tummy tuck/abdominoplasty, Higdon says.
The take-home message of the study’s findings is that surgery centers, including ASCs, have an extremely low risk for complications, Higdon says.
Also, office-based surgery centers are a reasonable alternative to ASCs and hospital surgery centers, he says.
“But triage has to be at the discretion of plastic surgeons,” Higdon says. “There can be a decrease in cost and better patient satisfaction without compromising safety.” n
REFERENCE
- Gupta V, Parikh R, Nguyen L, et al. Is office-based surgery safe? Comparing outcomes of 183,914 aesthetic surgical procedures across different types of accredited facilities. Aesthet Surg J 2017;37:226-235.
Research shows that aesthetic surgery conducted by accredited sites results in very few complications, regardless of whether surgery is performed in an office-based site, an ASC, or a hospital-based surgery site.
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