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Introduction: In 2000, Florida mandated that all physicians report all adverse events occurring in an office setting to a central collecting agency. The purpose here is to analyze the scope and incidence of adverse events and deaths resulting from office surgical procedures in Florida from 2000 to 2005. Methods and Materials: All reported adverse incidents (eg, the death of a patient or ahospital transfer) occurring after an office procedure as reported to the Florida Agency for Health Care Administration from March 1, 2000, through March 1, 2005, were reviewed. Additional information was gained via telephone follow-up and Internet searches. Results: Of 351 reported office adverse events, 110 occurred in association with an office surgical procedure—25 deaths and 85 hospital transfers. Thirteen complications and 5 deaths were clearly associated with use of intravenous sedation anesthesia or general anesthesia. Two deaths and 11 complications were at the hands of anesthesiologists with an MD or DO credential, 2 deaths were attributable to plastic surgeons using intravenous sedation, and 1 death and 2 hospital transfers were attributable to certified registered nurse anesthetists administering anesthesia. No adverse events were associated with use of dilute local (tumescent) anesthesia. Discussion: Dermatologists are currently under scrutiny by legislative and regulatory bodies because they perform liposuction under tumescent local anesthesia in an office setting. But the data from Florida, presented here and elsewhere, clearly show that dermatologists are not the problem. An extraordinarily high percentage of cosmetic surgery deaths and hospital transfers were attributable to board-certified plastic surgeons. A fair analysis of the data indicates that any restrictions on office procedures should start with the specialty demonstrating the most adverse events. State and/or national legislation establishing reporting systems for adverse events should be supported and should require the reporting of delayed deaths. Restrictions on dilute local (tumescent) anesthesia for liposuction would not reduce adverse events and could increase them if patients are forced into liposuction under deeper anesthesia.

Lemierre’s disease is characterized by sepsis, often with an oropharyngeal source, secondary septic emboli and internal jugular vein thrombosis (Lancet 1:701–3, 1936. Clin Microbiol Rev 20(4):622–59, 2007). Septic emboli affecting many bodily sites have been reported, including the lungs, joints, bones, and brain. The case report describes an unusual case of Lemierre’s disease in a 64 year old gentleman causing profound sepsis, acute kidney injury, bilateral iliopsoas abscesses and a right hand abscess. To our knowledge, this is the first reported case of Lemierre’s disease in the context of bilateral psoas abscesses, and highlights the ambiguity surrounding the definition of Lemierre’s disease. The clinical literature review highlights the difficulty in definitively diagnosing the condition and offers some suggestions for recognising and refining the diagnostic criterion of Lemierre’s.

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