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Liposuction cases are safe, according to study
National guidelines, patient education important
The recent action by the Florida Board of Medicine to restrict liposuction and abdominoplasty procedures in an office setting may call the safety of liposuction into question.
However, the latest liposuction study reports a complication rate of only 3% for 331 cases performed in office-based settings included in the study, according to the Accreditation Association for Ambulatory Health Care’s Institute for Quality Improvement (IQI) in Wilmette, IL.
The combination of adherence to national clinical practice guidelines, careful patient preoperative evaluations, and diligent monitoring during the procedure contribute to a low complication rate, says Sheila Ferguson, director of the Surgical Suite for Dermatology Associates of Atlanta, which participated in the study. "I’m surprised to see more patients requesting liposuction and wanting the procedure to be performed in a matter of days," she explains.
Patients usually have to wait a few weeks after the initial consultation for several reasons, including a busy surgery schedule as well as the facility’s insistence on complete lab work-ups and medical clearance from the patient’s family doctor if there are any medical problems, says Ferguson. "We also want the patient to have time to think about the procedure, to make sure they have read all the material we give them, to give them time to ask questions, and to ensure that they are making a fully informed decision," she adds.
The range of supranatant fat and fluid extracted in the study cases ranged from 10 ml to 13,700 ml, with a median of 2,075 ml and an average of 2,620 ml. In 12% of cases, more than 5,000 ml of fluid was extracted. Guidelines from the American Society of Plastic Surgeons (ASPS) in Arlington Heights, IL, recommend the procedure be performed inpatient if more than 5,000 ml is extracted. The American Academy of Dermatology (AAD) in Schaumburg, IL, and the American Society for Dermatologic Surgery in Rolling Meadows, IL, recommend that no liposuction be performed if more than 5,000 ml of aspirate is required, regardless of location.
Study participants reported a lidocaine dose range from 0-66 mg/kg, with a median of 26 mg/kg and an average of 25 mg/kg. Clinical practice guidelines from the AAD cite 55 mg/kg as a safe limit, while the more conservative guidelines of the ASPS recommend a maximum of 35 mg/kg total lidocaine dose.
Ferguson says postoperative pain is not a problem for her patients. "We give them prescriptions for a minimum number of pain pills, and we’ve only had one patient ask for a refill in the past several years," she explains.
Her facility provides a significant amount of preoperative education, and staff tell patients to start their medication as soon as they eat so that when the anesthesia wears off, they won’t feel pain, Ferguson says. "We also tell them to expect soreness as they heal." Because the patients aren’t surprised by the soreness during recovery, they don’t panic and think that it is a symptom of a complication or the beginning of pain, she explains.
Patients also aren’t complaining of pain during the procedure. Of the 98% of patients who responded to a one-week postoperative survey, 61% recalled their procedures, and 89% reported an intraoperative comfort rating of "1" (66%) or "2" (23%) on a scale of 1 to 5, with "1" equal to no discomfort.
There was only one aspect of the study’s findings that surprised Ferguson. "We only use intravenous sedation, and I did not know that general anesthesia still was being used by some surgeons," she says.
Of the 38% of cases where the type of anesthesia was listed and for which there were more than 10 cases, the following types of anesthesia were used:
Ferguson’s facility also administers prophylactic antibiotics for each case, as did 92% of the study participants.
"The types of antibiotics used for which there were more than three cases were cefazolin (53%), cephalexin (41%), and ampicillin (6%), says Naomi Kuznets, PhD, director of IQI.
A large number of patients included in the study were happy with the procedure: 94% of the patients contacted six months after the procedure rated their decision to undergo liposuction as positive, and 89% reported high levels of satisfaction with the procedure.
"I did not have one patient who I contacted after the study say that they regretted their decision," Ferguson adds. "They were all pleased with the lack of pain during and after the procedure, and with their results."
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