Are Risks of Adverse Outcomes Following Outpatient Cosmetic Procedures Additive When Procedures Are Combined

Purpose: The ability to study population-level outcomes of outpatient cosmetic procedures has been limited by a lack of longitudinal data from a variety of surgery centers.(1,2) This study aims to describe the rates of adverse events in patients who underwent an isolated cosmetic surgery procedure compared to those who had a combination of two procedures.

Methods: Retrospective longitudinal analysis was performed of the 2005-2010 California Office of Statewide Health Planning and Development (OSHPD) Ambulatory Surgery Database, which contains data for ambulatory surgery centers licensed by the California Department of Public Health. Patients were included if they had undergone an abdominoplasty or any other procedure that was identified as frequently performed concurrently with abdominoplasty - liposuction, breast procedures, face procedures, thighlift/brachioplasty, and hernia repair. Patients’ subsequent in-patient admissions and emergency department visits were identified from the respective OSHPD databases, capturing all admissions to non-military hospitals in the state.  Outcomes analyzed were the one-year venous thromboembolism (VTE) rate, 30-day readmission rate, 30-day emergency department visit rate, and 30-day mortality.  All outcomes were analyzed for patients undergoing an isolated procedure and two concurrent procedures.

Results: A total of 476,475 patients were analyzed of which 15,661 had undergone two concurrent procedures. In patients undergoing an isolated procedure, the 12-month VTE rate was 0.57% for abdominoplasty, 0.20% for liposuction, 0.12% for breast procedures, 0.32% for hernia repair, 0.28% for face procedures and 0.28% for thighlift/brachioplasty. Furthermore, 30-day mortality rates ranged from 0.03-0.09%, 30-day readmission rates ranged from 0.5-2.3%, and 30-day ED visit rates ranged from 1.7-4.3% depending on the procedure. Among patients who underwent two concurrent procedures, an additive VTE rate was observed among patients who underwent an abdominoplasty and liposuction (0.81%), and those who underwent an abdominoplasty and hernia repair (0.93%). In all other procedure combinations, the 12-month VTE rate was comparable or lower than that observed for the higher-risk procedure in isolation. No similarly additive risk was observed in 30-day readmissions or 30-day mortality measures.

Conclusions: Some combinations of elective outpatient procedures confer an additive VTE risk. This is an important consideration when informing patients of potential postoperative complications and may warrant VTE prophylaxis in such patients. However, most cosmetic procedures do not pose an increased risk of adverse outcomes when performed concurrently with one other procedure.