COMMENTARY

'I'm Having My Operation Overseas' -- What to Say When You Hear This

Joanna Gaines, PhD, MPH, MA, CHES

Disclosures

June 18, 2014

Editorial Collaboration

Medscape &

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Recently, the Centers for Disease Control and Prevention (CDC) identified 19 cases of nontuberculous mycobacteria wound infections among US residents who had undergone cosmetic surgery in the Dominican Republic.[1] Fourteen of these patients required hospitalization in the United States, with corrective surgery and long courses of antibiotic therapy.

I'm Dr. Joanna Gaines with the Travelers' Health Branch at CDC, here to discuss medical tourism and how you can help patients prepare to undergo medical procedures overseas.

Medical tourism is a multibillion-dollar industry and is expected to grow dramatically in coming years. People who travel internationally to receive care generally do so without incident, but any medical procedure involves risk, and this risk may be higher at poorly regulated or unaccredited facilities. If you have a patient who is planning to receive care in another country, there are several factors to consider.

First, your patient should determine whether the facility where the procedure will be performed is accredited by an internationally recognized accreditation organization. Examples of some of these organizations are provided under "Web Resources" below. Watch this video clip from a patient who did not investigate the overseas facility before having surgery.

Before the patient leaves, stress the need to coordinate follow-up care after his or her return to the United States. Financing for medical care outside the United States should also include the costs of necessary follow-up care. Provide your patient with relevant medical records that the overseas provider may need. If the patient does not speak the local language, make sure that he or she has a plan for communicating with providers.

If the patient will be flying, he or she should consider the risks associated with decreased oxygen concentration and barometric pressure. The trauma of surgery and possible sepsis increase oxygen consumption postoperatively, and oxygen delivery may be reduced in patients who are elderly or anemic or who have cardiopulmonary disease. These patients may need to delay air travel or receive supplemental oxygen during the flight.

Similarly, patients should delay air travel for at least 10 days after chest or abdominal surgery to avoid tearing of sutures or perforation associated with a reduction in cabin pressure. Although airplane cabins are pressurized, this is not equivalent to sea-level pressure. On most flights, cabin pressure is equivalent to 6000 to 8000 feet.

Recent major surgery is a known risk factor for deep vein thrombosis, although whether this risk is increased when patients fly soon after surgery is unknown. Patients should delay air travel after major surgery unless they are on prophylaxis for blood clots and are approved for travel by their surgeons; the length of the delay may vary depending on patient characteristics and the type of surgery. Before patients fly, they should take recommended preventive measures and be aware of the signs and symptoms of deep vein thrombosis and pulmonary embolism.

Finally, medical tourist procedures are often sold as a package that combines medical procedures with vacation activities. Make sure that your patient understands the risk and advisability of participating in vacation activities, such as sunbathing, drinking alcohol, or swimming, perioperatively.

With some counseling and guidance, you can prepare your patients who are traveling for medical care to have the best possible outcomes. For more information on safe and healthy travel, visit the CDC Website at www.cdc.gov/travel. Thank you.

Web Resources

CDC: Medical Tourism

CDC: Deep Vein Thrombosis and Pulmonary Embolism

CDC: Healthcare-Associated Infections

Aerospace Medical Association, Medical Guidelines Task Force. Medical guidelines for airline travel. 2nd ed.

International Accreditation Organizations

Accreditation Association for Ambulatory Health Care

DNV GL

The International Society for Quality in Healthcare

Joint Commission International

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