Complications of Cosmetic Surgery Tourism: Case Series and Cost Analysis

Abstract

Background Cosmetic surgery tourism is increasing exponentially. Patients seek cosmetic procedures within the United States and abroad, lured by lower cost procedures, shorter waiting lists, and affordable airfare and hotel accommodations. Unfortunately, operations are often performed by non–board-certified plastic surgeons, sometimes not even by plastic surgeons. Preoperative counseling, frequently limited to a video-chat with an office secretary, provides inadequate discussion regarding potential complications. Postoperative care is careless and rarely involves the operating surgeon. Complications are frequent, with management falling into the hands of plastic surgeons unfamiliar with the patient’s care. Furthermore, the physician, rather than the patient or hospital, faces the largest cost burden. Objectives The authors sought to explore their institution’s experience treating complications of cosmetic tourism and investigate associated costs. Methods The retrospective review of 16 patients treated for complications related to cosmetic surgery tourism plus cost analysis revealed a substantial discrepancy between money saved by undergoing surgery abroad and massive costs accrued to treat surgical complications. Results The most common complication was infection, often requiring surgery or IV antibiotics on discharge. Mean cost per patient was $26,657.19, ranging from $392 (single outpatient visit) to $154,700.79 (prolonged admission and surgery). Overall, the hospital retained 63% of billed charges, while physicians retained only 9%. The greatest amount paid by any single patient was $2635.00 by a patient with private insurance. Conclusions Cosmetic tourism has severe medical repercussions for patients and complications that burden hospitals, physicians, and the US medical system. Physicians treating the complications suffer the greatest financial loss. Level of Evidence: 4

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“…Recent analysis has shown that cosmetic surgery performed overseas carries significantly higher risks of complications, notably infection. 10…”

Cosmetic surgery treatment injuries: the New Zealand experience both at home and from cosmetic surgery tourism

“…This is a similar issue that overseas groups find when trying to assess the impact of complications arising from cosmetic surgery tourism on their own health systems. 7,8,[10][11][12] Some articles have attempted metaanalyses of a number of papers documenting treated complications but again the numbers are low and it is hard to assess the true impact. 9,19 Furthermore, while we may have some gauge on the medical complications, there is no literature assessing patient-reported outcomes or aesthetic outcomes from cosmetic surgery tourism.…”

“…5 The number of patients who receive cosmetic surgery overseas is unknown, and the numbers who have complications arising from this treatment are not accurately known either. Literature from overseas studies shows a measurable cost in the treatment of complications arising from cosmetic surgery tourism [6][7][8] and reflects the morbidity patients experience from complications arising from surgery in other countries. 9 Internationally there are concerns about infectious disease transmission of antibioticresistant bacteria from overseas surgeries.…”

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“…In addition, there is likely to be a difficulty with liaison with the surgeon after the patient has returned home, as well as difficulty in access to overseas surgical and hospital records. 39,40 The literature on such issues is growing with a review of 26 English patients who returned from overseas where they had undergone cosmetic procedures, in particular abdominoplasties and gluteal enhancement surgery, having complications costing the National Health Service an average of £5883 ($11095AUD) per patient. 41 The authors argued that 'Global governing bodies should focus efforts on educating patients and raising awareness on the everprevalent issue'.…”

“…The literature suggests that perioperative infections, including infections that may be antibiotic resistant, issues with blood transfusions in countries where blood products are not well monitored, and inadequate post‐operative care are amongst the risks run by persons who travel abroad for cosmetic surgery. In addition, there is likely to be a difficulty with liaison with the surgeon after the patient has returned home, as well as difficulty in access to overseas surgical and hospital records 39,40 . The literature on such issues is growing with a review of 26 English patients who returned from overseas where they had undergone cosmetic procedures, in particular abdominoplasties and gluteal enhancement surgery, having complications costing the National Health Service an average of £5883 ($11095AUD) per patient 41 .…”