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Safety and efficacy in an accredited outpatient plastic surgery facility: a review of 5316 consecutive cases.

Advances in medicine have improved the delivery of health care, making it more technologically superior than ever and, at the same time, more complex. Nowhere is this more evident than in the surgical arena. Plastic surgeons are able to perform procedures safely in office-based facilities that were once reserved only for hospital operating rooms or ambulatory surgery centers. Performing procedures in the office is a convenience to both the surgeon and the patient. Some groups have challenged that performing plastic surgery procedures in an office-based facility compromises patient safety. Our study was done to determine whether outcomes are adversely affected by performing plastic surgery procedures in an accredited outpatient surgical center. A retrospective review was performed on 5316 consecutive cases completed between 1995 and 2000 at Dallas Day Surgical Center, Dallas, Texas, an outpatient surgical facility. Most cases were cosmetic procedures. All cases were analyzed for any potential morbidity or mortality. Complications requiring a return to the operating room were determined, as were infection rates. Events leading to inpatient hospitalization were also included. During this 6-year period, 35 complications (0.7 percent) and no deaths were reported. Most complications were secondary to hematoma formation (77 percent). The postoperative infection rate for patients requiring a return to the operating room was 0.11 percent. Seven patients required inpatient hospitalization following their procedure secondary to arrhythmias, angina, and pulmonary emboli. Patient safety must take precedence over cost and convenience. Any monetary savings or time gained is quickly lost if safety is compromised and complications are incurred. The safety profile of the outpatient facility must meet and even exceed that of the traditional hospital-based or ambulatory care facility. After reviewing our experience over the last 6 years that indicated few complications and no deaths, we continue to support the judicious use of accredited outpatient surgical facilities by board-certified plastic surgeons in the management of plastic surgery patients.

Ambulatory Surgical Procedures↗

[Oculoplastic surgery implies restoration to "normalcy". Cosmetic surgery is performed only for congenital malformations or disease].

Ophthalmic plastic or oculoplastic surgery is the current term for the surgical treatment of disorders of the eyelid, the lacrimal apparatus and the orbit. The most frequent causes are congenital malformations, malpositions, abnormal motility, tumors and injuries. A good functional result with the best possible appearance is the goal; cosmetic surgery is performed only when the underlying cause is a malformation or disease. Several specialties have qualifications relevant to this field or parts of it; this article describes the tasks of an ophthalmologist working in this field and what he can accomplish.

Adult↗

[Perioperative use of medical hypnosis. Therapy options for anaesthetists and surgeons].

BACKGROUND: Surgical treatment of patients under local anaesthesia is quite commonly restricted by limited compliance from the patient. An alternative to treatment under pharmacological sedation or general anaesthesia could be the application of medical hypnosis. With this method, both suggestive and autosuggestive procedures are used for anxiolysis, relaxation, sedation and analgesia of the patient. PATIENTS AND METHODS: During a 1-year period of first clinical application, a total of 207 surgical procedures on a non-selected collective of 174 patients were carried out under combined local anaesthesia and medical hypnosis. RESULTS: Medical hypnosis proved to be a standardisable and reliable method by which remarkable improvements in treatment conditions for both patient and surgeons were achievable. CONCLUSION: Medical hypnosis is not considered to be a substitute for conscious sedation or general anaesthesia but a therapeutic option equally interesting for anaesthesists and surgeons.

Adolescent↗

Otolaryngology.

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Animals↗

Cost outcomes of facial plastic surgery: regional and temporal trends.

OBJECTIVE: To describe the geographic and temporal trends in cosmetic facial plastic surgery procedure costs and frequency during the last decade and to evaluate factors that may influence changes in the demand for cosmetic procedures. METHODS: A survey sent to every (N = 1727) active fellow, member, or associate of the American Academy of Facial Plastic and Reconstructive Surgery assessing the costs and frequency of 4 common cosmetic facial plastic surgery procedures (ie, face-lift, brow lift, blepharoplasty, and rhinoplasty) for 1999 and 1989. RESULTS: The annual frequency of the aging-face procedures (ie, face-lift, brow lift, and blepharoplasty) have increased 41% over the last decade while rhinoplasties have declined slightly (18%). Each of the procedures studied have increased in cost since 1989; however, only face-lifts have increased at a rate greater than inflation during this period (average surgeon's fees, $3154-$4582). Although the average cost of each of these procedures is stable across US geographic areas, there seem to be fewer aging-face procedures being performed in the East (represented largely by New England and the northeastern states) compared with the Midwest, South, and West (P< or = .03), while rhinoplasty frequency across these regions is essentially unchanged. In addition to variables such as age, years in practice, and degree of marketing, the strongest correlates with increased cosmetic procedure frequency were the costs of these procedures (P< or = .008). CONCLUSIONS: Although the cost and frequency of cosmetic facial plastic surgery procedures continues to rise across the United States, there are interesting differences in these trends between different regions and procedure type during the last decade. There also seems to be an association between increased cost and increased frequency of these cosmetic procedures.

Aged↗

PLASTIC surgery.

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Nasal Surgical Procedures↗