Office-based Plastic Surgery—Evidence-based Clinical and Administrative Guidelines

Abstract

Summary: Outpatient procedures are extremely prevalent in plastic surgery, with an estimated 82% of cosmetic plastic surgery occurring in this setting. Given that patient safety is paramount, this practical review summarizes major contemporary, evidence-based recommendations regarding office-based plastic surgery. These recommendations not only outline clinical aspects of patient safety guidelines, but administrative, as well, which in combination will provide the reader/practice with a structure and culture that is conducive to the commitment to patient safety. Proper protocols to address potential issues and emergencies that can arise in office-based surgery, and staff familiarity with thereof, are also necessary to be best prepared for such situations.

Liposuction Complications in the Outpatient Setting: A National Analysis of 246,119 Cases in Accredited Ambulatory Surgery Facilities

“…Aesthetic surgeries have transitioned from occurring primarily in hospital settings to being almost exclusively outpatient, with approximately 82% of procedures taking place in the ambulatory setting in 2020. 11 Oppositely, the majority of research surrounding cosmetic surgery has been based on inpatient data. Therefore, this analysis of liposuction complications from procedures performed in outpatient QUAD A–certified facilities aims to open a window into the ambulatory surgery space on a national level.…”

Are Caprini Scores and Chemoprophylaxis Necessary to Reduce the Risk of Venous Thromboembolism after Abdominoplasty?

“…Zhang et al 1 state that plastic surgeons must assess venous thromboembolism (VTE) risk by recording predisposing conditions and lifestyle factors. Interestingly, Pannucci et al 2 recently reported that 80% of women who develop VTE after breast augmentation are likely to have Caprini scores less than or equal to 6.…”

“…The authors agree with the consensus panel of the American Association of Plastic Surgeons 4 in stating, “there is no all-encompassing recommendation regarding VTE chemoprophylaxis based on Caprini stratification and surgeons should use clinical judgment when evaluating patients for VTE management.” 1 However, the authors go on to say that abdominoplasty is an exception and that studies have shown a benefit in using VTE chemoprophylaxis in abdominoplasty patients. Four references are cited.…”

“…Zhang et al 1 do not reference any articles that challenge the value of Caprini scores or the efficacy of chemoprophylaxis. [6][7][8][9] Contradictory evidence cannot be ignored.…”

Assessing the Influence of Intraoperative Core Body Temperature on Postoperative Venous Thromboembolism after Abdominal Wall Reconstruction

“…Intraoperative core body temperature is a surgical factor that has been previously associated with thrombotic events after surgical procedures such as ovarian cytoreductive surgery, intracranial tumor resection, and various forms of microsurgical free tissue transfer. [7][8][9][10][11][12] Although investigations from the basic science literature have suggested that mild hypothermia might protect against thrombosis due to inhibition of platelet function and the clotting cascade, results from these studies have been discordant with clinical studies. [13][14][15] Thus, the question arises whether intraoperative core body temperature may be a predictive factor of VTE after CAWR.…”