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A Review of Liposuction, Abdominoplasty and Facelift Mortality And Morbidity Risk Literature

Robert A. Yoho, MD
Assistant Professor, Department of Dermatology
Martin Luther King-Drew Medical Center
12021 South Wilmington Avenue
Los Angeles, CA 90059

Jeremy J. Romaine, MPAS, PA-C
Private Practice
797 S. Arroyo Parkway
Pasadena, CA 91105

Deborah O'Neil, PhD
797 S. Arroyo Parkway
Pasadena, CA 91105

Correspondence: Robert A. Yoho, 797 S. Arroyo Parkway, Pasadena, CA 91105
Voice: (626) 585-0800; Fax (626) 585-8887; ryrobert@pacbell.netDrYoho.com


Abstract

Background: The statistical discrepancies that exist in mortality and morbidity risk literature are such that surgeons and patients cannot accurately assess the true risk rates associated with plastic surgery procedures.

Objectives and Methods: To review any relevant literature published to date in which risk rates from liposuction, abdominoplasty, and rhytidectomy are cited and reassess these figures alongside those published for both elective and emergency general surgeries.

Results and Conclusion: Despite the lack of reliable, comprehensive reporting of deaths and complications resulting from cosmetic surgeries, published data demonstrates that the risks associated with liposuction and rhytidectomy compare favorably with those from most general surgical procedures. In contrast, morbidity and mortality rates from abdominoplasty remain unacceptably high. Significant lack of literature documenting cosmetic breast implant surgery and blepharoplasty risks are observed, which should be of concern to both patient and physician. Liposuction and facelift surgery data generally show that surgical centers are statistically safer than hospital operating rooms, although the data has not been standardized for the patients' American Society of Anesthesiologists (ASA) risk class, the health of the patient prior to surgery. General anesthesia may carry a risk roughly equivalent or perhaps greater than cosmetic surgery, although again ASA class variables confound clear comparison between studies. Recent anesthesia literature refutes the many claims that general anesthesia risks are now remote: a landmark study (Lagasse et al 2002), which surveyed the entire scholarly literature, showed a mortality rate of 1/13,000, roughly similar to overall cosmetic surgery mortality risks. Moreover, prolonged operating time has been repeatedly implicated in other surgical literature to be related to morbidity and mortality. The latter certainly has relevance to cosmetic surgery.

"If you do this work, expect trouble." Julius Newman, MD

The consent process for cosmetic surgery has been raised to a higher and higher standard by the plaintiff's bar. Once a handshake and verbal acknowledgement that serious complications or even death could occur were considered reasonable prior to surgery. Now, patients are often presented with consent forms containing the minutia of every risk, regardless of their likelihood. In the interest of providing surgeons and their patients the most realistic picture of the risks related to cosmetic surgery, we have re-analyzed and attempted to standardize the relevant mortality and morbidity statistics published for these procedures and compared them for reference to other types of mortality figures. We also compared these statistics with general surgery's risk rates for selected surgeries. A significant proportion of the data included in this review was obtained from survey studies, but the overall message we present will still provide a better understanding of cosmetic surgery risk rates and will hopefully allow consumers and surgeons to estimate the risks of cosmetic surgeries.

Before addressing individual procedures, however, it is important to bluntly assess the risk of cosmetic surgeries in the context of those for elective and emergency general surgical procedures (Table 1) and to also compare these risks rates to current general mortality rates (Table 2). In doing so, it is clear that, with the exception of abdominoplasty, even the highest incidences of mortality for cosmetic procedures reported to date are lower than the overall general surgical risk rate and fare log orders better than the risk associated for major abdominal or cardiac surgery (Table 1). This reflects in part that elective cosmetic surgery candidates will on average be in a better state of health (lower ASA class) at the time of surgery compared to their counterparts undergoing non-elective or emergency surgeries. By way of reference and to better understand the statistics, the annual chances of dying from accidents, in childbirth or being murdered in the United States are in the same order or less than the risk of dying on the cosmetic/plastic surgerons' table during the course of most cosmetic procedures (Table 2). The notable exception is abdominoplasty ("tummy tuck"), which carries far higher risk.


Table 1. Surgical Mortality Risk

Surgical Procedure

Highest Calculated Fatality Rate

General surgeries:  
Overall general surgery risk rate 1/5001, 2 *
Overall anesthesia risk 1/13,0002 **
Esophagectomy 1/54
Pancreatic resection 1/64
Mitral valve replacement 1/74
Caesarian section 1/1000 - 1/30005
Emergency cholecystectomy 1/306
Delayed cholecystectomy 1/200 under age 606
Appendectomy 1/5004
Gastroplasty for weight reduction 1/200 ? 1/3004, 7
 
Cosmetic surgeries:  
Liposuction 1/5,2248,0/15,3369 - 0/66,57010***
Abdominoplasty 1/6007, 11
Facelift 1/1,0007

* Veterans hospital statistics actually show surgical mortality of several percent, figures so radically worse than the rest that we excluded them from the data. Their general surgeon's mortality rate with each procedure exceeds 5 percent12. Plastic surgery mortality was reported as 0.6 percent. Poor overall patient health and physician training may be contributors to their statistics.

** A recent study credibly reports a mortality rate of 1/13,000.

*** Dermatologic surgeries performed between 1994?2000.

Note: the ASA class of cosmetic surgery patients is usually I or II: they are relatively healthy. Other (general) surgery patients in the students above include all classes of patients, including the very ill, confounding direct comparison of the above statistics.


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