Dying to Look Good: Fatal Pulmonary Embolism Following Florida Office-Based
Surgery
Hector Vila M.D., Jonathan Cohen M.D., and Michael Augustyniak M.D.
Department of Anesthesiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida and Department of Anesthesiology, University of South Florida College of Medicine, Tampa, Florida

Introduction: As the number of office-based cosmetic surgeries increases each year, the need to ensure the safety of these patients also grows. Greater scheduling control, increased patient privacy, convenience, and cost are among the touted benefits of office-based cosmetic surgery. Although the advantages have increased, the risks must also be considered. Among these risks is the development of a fatal pulmonary embolism. Many factors have been associated with increased risk of developing a venous thromboembolism, including advancing age, increasing body mass index, malignancy, and cigarette smoking. The Seventh American College of Chest Physicians (ACCP) Conference on Antithrombotic and Thrombolytic Therapy recently published guidelines for the risks and recommended therapies for venous thromboembolism1.
Grazer and de Jong studied fatal outcomes from liposuction and found the mortality rate from liposuction was about 20 per 100,0002. When compared to the mortality rate from motor vehicle accidents of 16.4 per 100,000, the hidden dangers of liposuction become more evident. Pulmonary thromboembolism was found to be the leading cause of death.
Methods: In December 2004, the Florida Board of Medicine released a report on physician office deaths and numbers of cosmetic procedures performed from January 2000 through September 2004. All of these cases were reviewed. Those deaths not related to office-based surgery (i.e. chemotherapy, dialysis) were excluded from calculations. Post operative deaths attributed to pulmonary embolism were extracted and the death rate was obtained by using the total number of cosmetic procedures reported and statistics from the American Society of Plastic Surgeons3.
Results: Thirty-eight percent of office-based surgery deaths occurred in the post-operative period (between five hours and nine days post-procedure). Of the deaths that occurred post-procedure, 64% died as a result of pulmonary embolism. All but one of these patients had an abdominoplasty procedure performed. Two-thirds of the patients who died after abdominoplasty, had the procedure combined with another aesthetic procedure, most commonly liposuction. From July 2000 through September 2004, an estimated 12,950 abdominoplasty procedures were performed. Six of these resulted in death, which
corresponds to a death rate of 4.6 for every 10,000 abdominoplasty procedures. This statistic compares with a previously published report by Hughes which cited a death rate of approximately 3.3 per 10,0004.
Conclusion: Pulmonary embolism is a major cause of death following office-based abdominoplasty in Florida. Anesthesiologists must familiarize themselves with the risk factors as identified by the ACCP for development of venous thromboembolism and treat these patients accordingly. Patients with several risk factors may not be candidates for office-based procedures. Early post-operative ambulation, adequate hydration and use of anti-thrombotic devices should be encouraged. Further research may be warranted to address the possibility that there are mechanisms unique to the abdominoplasty procedure that make patients more prone to developing venous thromboembolism.
References:
1. The Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. Prevention of Venous Thromboembolism. Chest. 126:338S-400S, 2004.
2. Grazer F.M., and de Jong, R.H. Fatal Outcomes from Liposuction: Census Survery of Cosmetic Surgeons. Plastic and Reconstructive Surgery, 105(1):436-446, 2000.
3. American Society of Plastic Surgeons website accessed February 14, 2005.
4. Hughes, C.E. Reduction of Lipoplasty Risks and Mortality: An ASAPS Survey. Aesthetic Surgery Journal, 21(2):120-127, 2001.

TOP

© SOCIETY FOR AMBULATORY ANESTHESIA
520 N. Northwest Highway Park Ridge, Illinois 60068-2573
Tel: (847) 825-5586 Fax: (847) 825-5658
E-mail: samba@asahq.org