Tracking Complications and Unplanned Healthcare Utilization in Aesthetic Surgery: A Nationwide Analysis of 214,504 Patients using the TOPS Database

Abstract

Background: Tracking surgical complications and unplanned healthcare utilization is essential to inform quality initiatives in aesthetic surgery. This study used the Tracking Operations and Outcomes for Plastic Surgeons database to characterize rates and predictors of surgical complications and unplanned healthcare utilization across common aesthetic surgery procedures. Methods: The Tracking Operations and Outcomes for Plastic Surgeons database was queried for all patients undergoing breast augmentation, liposuction, blepharoplasty, rhinoplasty, and abdominoplasty from 2008 to 2019. Incidence and risk factors for complications and unplanned readmission, reoperation, and emergency room visits were determined. Results: A total of 214,504 patients were identified. Overall, 94,618 breast augmentations, 56,756 liposuction procedures, 29,797 blepharoplasties, 24,946 abdominoplasties, and 8387 rhinoplasties were included. A low incidence of perioperative complications was found, including seroma (1.1%), hematoma (0.7%), superficial wound complication (0.9%), deep surgical-site infection (0.2%), need for blood transfusion (0.05%), and deep venous thrombosis/pulmonary embolism (0.1%). Incidence of unplanned readmission, emergency room visits, and reoperation were 0.34%, 0.25%, and 0.80%, respectively. Patients who underwent an abdominoplasty more commonly presented to the emergency room and had unplanned readmissions or reoperations compared with other studied procedures. Furthermore, increased age, diabetes, higher body mass index, American Society of Anesthesiologists class, longer operative times, and pursuit of combined aesthetic procedures were associated with increased risk for unplanned health care use. Conclusions: There is a low incidence of perioperative complications and unplanned healthcare utilization following common aesthetic surgery procedures. Continued entry into large national databases in aesthetic surgery is essential for internal benchmarking and quality improvement. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.

Measuring Outcomes in Aesthetic Surgery by Board Certified Plastic Surgeons

“…These most commonly include hematoma formation, wound-healing complications, surgical-site infection, and venous thromboembolism. 23,24…”

“…These most commonly include hematoma formation, wound-healing complications, surgical-site infection, and venous thromboembolism. 23,24 Aesthetic procedures are typically underrepresented in large national multi-institutional surgical data sets, such as ACS-NSQIP, and are generally not included in insurance claimsbased databases. An exception is CosmetAssure, an insurance policy available nationally that covers some complications of cosmetic surgery; however, its database does not include complications that are not covered by the insurance policy, such as infections that do not require intravenous antibiotics or wound dehiscence treated nonsurgically.…”

“…Among a variety of plastic surgery procedures, TOPS includes cosmetic procedures and has been used successfully to study postoperative complications in breast augmentation, liposuction, blepharoplasty, rhinoplasty, and abdominoplasty. 23,24 The major disadvantage of TOPS is its reliance on voluntary self-reported data. 25 Furthermore, it is more difficult to obtain hospital buy-in for tracking procedures because the overall complication rate is low.…”