Office Surgery Incidents: What Seven Years of Florida Data Show Us

Abstract

Plastic surgeons were responsible for an inordinate number of deaths and hospital transfers. Requiring physician board certification and physician hospital privileges would not seem to increase safety, because most physicians already have these credentials, and physicians without these credentials were not responsible for a disproportionate share of incidents. These data do not show an emergent hazard to patients from medically necessary office surgery. Liposuction under general anesthesia deserves continued scrutiny because deaths due to this procedure continue to occur and this procedure can be performed with dilute local anesthesia, with which no deaths were reported. Mandatory reporting of office incidents should be strongly supported, as well as reporting of incidents that occur after surgery in the hospital outpatient department and ambulatory surgery center. These data should be available for analysis after protecting patient confidentiality. A national debate needs to occur to determine how many deaths and injuries are acceptable from cosmetic procedures performed under general and intravenous anesthesia.

Efficacy of Ultrasound Cavitation, Tripollar Radiofrequency Lipolysis and Combination Therapy on Abdominal Adiposity

“…Significant circumference reduction effect may indicate a 50% greater mean circumference reduction than was achieved by a single treatment session of either treatment alone [21]. Also, Coldiron (2008) reported several explanations for the increased efficacy of the combined US and RF modalities. While the disruption of adipocytes is achieved only by the US cavitation, the application of RF treatment may increase its effect and the free fat clearance from the treated area.…”

“…While the disruption of adipocytes is achieved only by the US cavitation, the application of RF treatment may increase its effect and the free fat clearance from the treated area. However the combination of therapies does not add up to a thermal injury to adjacent tissues such as blood vessels, nerves or skin [22].…”

Estimated Maximal Safe Dosages of Tumescent Lidocaine

“…Multiple large surveys involving thousands of procedures have found no evidence of tumescent lidocaine toxicity at recommended dosages. [50][51][52] However, 55 mg/kg may be too risky if lidocaine absorption is too rapid (failure to add epinephrine to the solution of tumescent lidocaine) or if lidocaine metabolism is too slow (diabetes, 53 adverse interactions with drugs that inhibit the hepatic microsomal isoenzymes cytochrome P450 3A4 and 1A2 such as erythromycin, 54 sertraline, fluconazole or ciprofloxacin, propofol, 55 or general anesthesia 56 ) or if patients have very low serum protein concentrations or if surgery is cancelled before liposuction can be completed. Based on the present data and considerable worldwide experience, we believe that 45 mg/kg is a safe and prudent maximum dosage of tumescent lidocaine for liposuction.…”

Técnicas Não Invasivas Para Redução Da Lipodistrofia Localizada: Evidências Atuais. Ênfase No Tratamento Com Criolipólise.

“…O procedimento de lipoaspiração está associado a um grande índice de complicações potenciais tanto decorrentes do processo operatório e pós-operatório, tais como fibrose, necrose, embolias gordurosas, choque hipovolêmico, risco de lesões em órgãos internos, hemorragias, infecções, seromas, imperfeições estéticas de cicatrização e hipercromias, além do risco de mortalidade, e ainda, das limitações da rotina diária e breve acamamento após a realização do procedimento até a total recuperação cirúrgica (3)(4)(5)(6). Em decorrência desses fatores, as inovações tecnológicas de recursos não invasivos para o tratamento estético da lipodistrofia localizada são alternativas que apresentam bons resultados e tem sua procura aumentada no mercado, uma vez que possibilitam a redução de medidas sem interferência na vida diária do indivíduo e com o mínimo de efeitos colaterais (3,6).…”