Florida Office-Surgery Moratorium on Combined Liposuction/Abdominoplasty: Position of the American Society for Aesthetic Plastic Surgery

New York, NY (February 13, 2004) — The American Society for Aesthetic Plastic
Surgery (ASAPS) supports the Florida Board of Medicine's investigation into
a small but significant number of patient deaths associated with surgical procedures,
including plastic surgery, performed in office-based surgical facilities. However,
ASAPS believes that the Board's recent vote to enact a 90-day moratorium on
the combination of liposuction and abdominoplasty (tummy tuck) in office-based
facilities may not address the root causes of the problem.

“As the leading organization of board-certified plastic surgeons who specialize
in cosmetic plastic surgery, ASAPS is committed to patient safety,” says plastic
surgeon and ASAPS President Robert Bernard, MD. “There is no question that
we support the continued study of the safety of office-based procedures.”

Dr. Bernard says he understands the Florida Board's desire to act quickly
and decisively and therefore hopes the 90-day ban will provide a cooling off
period, during which time all members of the Florida medical community can
be involved in proposing meaningful policies to provide the highest levels
of patient safety. “Our concern is that it is easy to jump to a conclusion
based on limited information. We want the Board to do its due diligence before
enacting far-reaching restrictions impacting patient care.”

Data on patient mortality must always be examined in the context of the total
number of procedures performed and expected risks. Dr. Bernard says that it
has not yet been determined whether the problems experienced in Florida are
related to particular types of procedures or to other factors. “Past history
has shown that often the problem is the lack of appropriate patient selection,
facility standards or physician training,” says Dr. Bernard. ASAPS has participated
in development of recommended guidelines for office-based surgery, and has
long been on record supporting mandatory facility accreditation. It enforces
a policy that requires its own members to operate only in accredited, state-licensed
or Medicare-certified surgical facilities.

According to ASAPS statistics, more than 83,000 Americans had tummy tucks
and nearly 373,000 underwent liposuction (also called lipoplasty) in 2002.
Results of a survey on lipoplasty safety ( Aesthetic Surgery Journal ,
2001) covered 94,000 lipoplasty procedures performed by board-certified plastic
surgeons. Results showed that the estimated risk of death from lipoplasty performed
as an isolated procedure was 1 per 47,415 procedures. When combined with abdominoplasty,
the risk was significantly higher – 1 per 3281. (For comparison, the risk of
death from elective bariatric surgery is reported to be 48 in 3073 [ Surg
Endosc
. 2003].) However, the extent of lipoplasty performed
or other factors contributing to increased risk of lipoplasty/abdominoplasty
combinations could not be determined by the survey data, leaving these questions
unanswered.

“More research on this issue is needed,” acknowledges Dr. Bernard. He contends,
however, that a small amount of liposuction performed in conjunction with an
abdominoplasty should not significantly increase risks. “The distinction should
be made between very limited fat removal, done as part of the tummy tuck operation
itself, and the combination of abdominoplasty with more extensive liposuction
often involving other areas of the body.”

Safety of Office-Based Surgery

The safety of office-based surgery in accredited facilities is well
established:

  • A recent study analyzed over 400,000 procedures performed by
    board-certified surgeons in accredited outpatient facilities. Researchers conclude
    that their data document the safety for procedures performed by board-certified
    surgeons who have credentials to perform the same procedures in both a hospital
    and an accredited outpatient setting. The incidence of patient deaths after
    outpatient procedures was 0.002% or 1 in 51,459. [Note: The study was conducted
    by the American Association for Accreditation of Ambulatory Surgery Facilities
    (AAAASF) and is pending publication in a nationally recognized, peer-reviewed
    medical journal.]

  • A review of 3,615 consecutive patients undergoing 4,778 outpatient
    plastic surgery procedures performed by multiple surgeons under monitored anesthesia
    care/sedation in a single office-based facility between May of 1995 and May
    of 2000 reported no deaths or life-threatening complications. ( Plast Reconstr.
    Surg.
    111: 150, 2003).

  • Peer-reviewed, published data on plastic surgery performed in
    accredited office-based facilities showed a complication rate of less than
    half of one percent in over 400,000 procedures. ( Plast. Reconstr. Surg .
    99: 1496, 1997).

  • A report on more than 23,000 consecutive office-based procedures
    under general anesthesia showed no significant anesthetic complications. ( Plast.
    Reconstr. Surg
    . 107: 243, 2001).

  • According to statistics from the American Society for Aesthetic Plastic
    Surgery (ASAPS), in 2002, 45% of all cosmetic procedures were performed in
    office-based surgical facilities. Office-based surgery provides a safe, convenient
    and cost-effective alternative for many patients. Most insurance companies
    accept accredited office-based facilities as equivalent to hospitals for
    reimbursement of covered procedures, recognizing their proven safety and
    cost effectiveness.

About ASAPS
The American Society for Aesthetic Plastic Surgery (ASAPS), is recognized as the world’s leading organization devoted entirely to aesthetic plastic surgery and cosmetic medicine of the face and body.  ASAPS is comprised of over 2,600 Plastic Surgeons; active members are certified by the American Board of Plastic Surgery (USA) or by the Royal College of Physicians and Surgeons of Canada and have extensive training in the complete spectrum of surgical and non-surgical aesthetic procedures. International active members are certified by equivalent boards of their respective countries. All members worldwide adhere to a strict Code of Ethics and must meet stringent membership requirements.

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