Plastic surgeons at Vanderbilt University Medical Center (VUMC) have published a prospective study that proves there are specific risk factors — such as obesity, smoking and diabetes — that contribute to development of a major surgical site infection following cosmetic surgery.
Data from more than 129,000 patients undergoing 24 different aesthetic surgeries from 2008 to 2013 at a variety of plastic surgery practices across the United States was analyzed for the research, recently published in the Aesthetic Surgery Journal. The investigators used a database from CosmetAssure, an insurance program that covers the cost of unexpected major complications from cosmetic surgery performed by board-certified or board-eligible plastic surgeons.
Past studies looking at complications following cosmetic surgery have been limited by small sample sizes, the use of data from a single surgery center and often a focus on a single type of surgical procedure, so the scientific literature on the topic has been narrow. This study — the first to use a substantial, multi-institutional sample — is significant in that it provides a more “real life” picture of outcomes by using a large national data source, said study co-author Kye Higdon, M.D., assistant professor of Plastic Surgery.
The overall incidence of major complications following aesthetic procedures was shown to be very low; out of the cases analyzed, only 0.46 percent, or 599 patients, developed a major postoperative surgical site infection.
“We didn’t look at minor infections, but rather major infections that required an emergency room visit, a hospital admission or a re-operation within 30 days of the initial cosmetic surgery,” said lead author Chris Kaoutzanis, M.D. “We identified several predictors for major surgical site infection, including older age, female gender, obesity, smoking, having diabetes, having surgery at a hospital or ambulatory surgery center as opposed to an office-based surgical suite, procedures performed on the trunk and extremities as opposed to breast and face, as well as combining aesthetic surgical procedures.”
Awareness of the risk factors contributing to major infections for these commonly performed cosmetic procedures will provide better support to plastic surgeons, as they will be able to provide improved patient education before surgeries, as well as improved surgical planning to enhance patient safety, Kaoutzanis added.
Of the significant predictors of surgical site infection identified, several could be positively impacted by modifications in patient behavior, such as losing weight, quitting smoking or better management of diabetes.
“The impact of a major infection can be devastating for patients, and the importance of this study is to try to avoid that complication entirely,” Higdon said. “This study gives doctors the ability to use evidence-based medicine in their cosmetic surgery practice. They can tell patients, ‘You know, your body mass index or your smoking or your diabetes puts you at a higher risk for complications after surgery.’ Doctors can have a professional, informed consent by presenting this information to patients.
“These are risk factors that doctors have talked about being risk factors for years, but it’s never been proven to such a high degree of certainty for this population of patients.”
Obesity has been a well-established risk factor for surgical site infections in many types of surgery, including cosmetic surgery, and this study supported that finding as well.
The study clearly shows a statistically significant increase in major infection rates in patients with increasing body mass index (BMI). The infection rate doubles as a patient’s weight increases from normal or healthy weight to overweight. The surgical site infection rate doubles again for an obese patient, and the rate continues to increase for the morbidly obese patient.
Patients who smoke had a 61 percent increase in the risk for a surgical site infection, compared to non-smokers. This finding falls in line with other scientific studies over the past few decades that indicate smoking has an enormous impact on wound healing. One theory for this is that nicotine decreases blood flow through the skin by constricting the blood vessels, which then impairs healing.
The study also compared the number of surgical site infections for a single procedure (0.3 percent) to the infection rate when multiple procedures were combined during one surgery, such as an abdominoplasty and a facelift (0.8 percent infection rate).
This could be attributed to the increased amount of time spent in the operating room, as well as to the increased number of surgical sites, which causes more stress to the body as it attempts to heal, said Higdon.
“Now, because of this data, we’re able to have better conversations with our patients and show them data that indicates exactly what the risks are, so we can give them a better understanding of what’s safe and what might be in their best interest,” said Higdon. “This study reaffirms and validates our pattern of practice that has been followed for many years here at Vanderbilt.”
