Office Surgical Incidents: 19 Months of Florida Data

Abstract

Liposuction under general anesthesia deserves closer scrutiny. Office accreditation is not associated with fewer patient injuries and deaths. Restrictions on tumescent liposuction, conscious sedation and intramuscular sedation and analgesia would not yield any saved lives or fewer injuries since these modes of anesthesia resulted in no injuries or deaths. Board certification and hospital privilege requirements for office practice would have very little effect since the vast majority of reporting physicians already had these credentials. These data do not show an emergent hazard to patients from office surgery This data strongly contradicts the lay media portrayal of the dangers of office procedures. Mandatory reporting of office incidents should be strongly supported, and this data should be available for analysis after protecting patient confidentiality.

Tumescent liposuction: A review

“…[33] A review of the State of Florida adverse event data revealed that there were no tumescent anesthesia-related liposuction deaths. [34] In contrast, there were two deaths related to liposuction under general anaesthesia. Safety of office-based liposuction as opposed to hospital-based liposuction too has been well documented.…”

Patient safety

“…In short, the data suggest that dermatologic surgery and liposuction under dilute local (tumescent) anesthesia were associated with a very low incidence of adverse events. [6][7][8][9][10][11] Specifically, prospective data from 7 years of mandatory reporting in Florida indicated that dermatologists had not been responsible for a single death. In addition, there were no deaths or hospital transfers associated with liposuction under dilute local anesthesia.…”

“…7 The Florida data suggest that stringent requirements for physicians performing office-based surgery, such as board certification, maintenance of hospital privileges, and office accreditation would have had little effect on the incidence of severe adverse events, because most of the physicians involved were board certified and had hospital privileges, and about 46% of the surgeries resulting in death occurred in accredited offices. 7 In one study of 400,000 procedures, the adverse event rate was 0.47%, with a mortality rate of one per 57000 procedures. 14 In another study of 4778 consecutive patients under intravenous sedation, there were no deaths and only 12 anesthesia incidents.…”

Safety of liposuction using tumescent local anesthesia

“…Florida is currently the only state with mandatory reporting of all office incidents that result in major complications, death, wrong-site surgery or hospital transfer. Coldiron reviewed the first 19 months of the Florida data and found eight reported deaths and 43 procedure-related complications [15]. The most common cause of outpatient complications and death was liposuction under general anesthesia.…”