Quality and Safety Review Of Plastic Surgery Procedures Outcomes In The State Of California

Purpose: Hospital accreditation varies somewhat across states, but all must obtain licensure to function as a hospital and in California this includes accreditation by the joint commission. However, of the 4 million cosmetic procedures performed annually, the majority of those procedures were not performed in hospitals.  Ambulatory surgery centers (ASC) are not constrained by the same guidelines. Several accrediting bodies attempt to standardize quality, but no research to date has shown if the risk of post operative complications are equal across institutions. Studies have shown the rate of venous thromboembolism events (VTE)  associated with cosmetic surgery vary widely from 0.39% to 9%.  We sought to determine if all outpatient surgery centers have similar rates of VTE by type of cosmetic procedure.

Methods:A retrospective review was performed of all data collected over a 5 year period by the Office of Statewide Health Planning and Development(OSHPD).  All licensed ambulatory surgery centers in California must report encounters via the Medical Information Reporting for California (MIRCal) system.  All cases were performed between 2005 and 2010. Those facilities with fewer than 25 cases over 5 years were excluded from analysis.  The rate of VTE associated with abdominoplasty was obtained for each center by extracting CPT codes from the OSHPD database.  

Results:3646 patients were treated at 61 ASC.  After abdominoplasty, the average rate of VTE for all ASC was 0.71%, with a range of 0-5.7%.  30-day hospital admission rate was 2.36% with a range of 0-8.82%.  30-day Emergency department visits averaged 3.92%, with a range of 0-24.2%.          

Conclusions: Our data analysis shows significant variability in the rate of VTE and 30 day readmission rates.  This should exemplify the need for regular reporting regardless of accreditation status. The surgeon as the leader of the team has a responsibility to the patient to ensure a safe experience. Accreditation is not necessarily the answer, but reporting of cases and morbidity may help to make ambulatory surgery safer for our patients. Also, surgeons should always consider the use of VTE prophylaxis in patients with additive risks.