An Update on the Safety and Efficacy of Outpatient Plastic Surgery

A Review of 26,032 Consecutive Cases

Rod J. Rohrich, M.D.; Bernardino M. Mendez, M.D.; Paul N. Afrooz, M.D.


Plast Reconstr Surg. 2018;141(4):902-908. 

In This Article

Patients and Methods

A retrospective review was performed on 26,032 consecutive cases completed between the years of 1995 and 2017. All cases were performed by board-certified plastic surgeons at an American Association for Accreditation of Ambulatory Surgery Facilities–accredited outpatient surgical center, the Dallas Day Surgery Center. Multiple procedures were performed on some patients, but the overall number of cases (26,032) does not reflect multiple procedures. A majority of cases were cosmetic procedures, including rhytidectomy, brow lift, blepharoplasty, rhinoplasty, otoplasty, laser resurfacing, chemical peels, breast augmentation, mastopexy, liposuction, abdominoplasty, and gluteal fat augmentation. A small number of cases were reconstructive and hand/upper extremity related.

All cases were reviewed for potential mortality and morbidity events, including hematoma, seroma, infection, wound dehiscence, and venous thromboembolic events (either deep vein thrombosis or pulmonary embolism). The morbidity events measured included early postoperative complications (occurring within 48 hours after surgery) and those requiring return to the operating room. Variables were analyzed to determine potential risk factors for postoperative complications, including age, body mass index, operative time, lipoaspirate amount, and whether the procedure was a combined case.

Patients that required postoperative monitoring were transferred to a hotel adjacent to our surgical suites that is staffed full time by a registered nurse. The decision for postoperative monitoring was made (usually preoperatively) by the patient's plastic surgeon and anesthesiologist based on medical comorbidities, duration of case/anesthesia, large lipoaspirate amounts, and combined cases. Complications/events that prompted transfer to inpatient admission (from the postanesthesia care unit or hotel suite) included uncontrolled pain, hypovolemia, arrhythmia, altered mental status, respiratory failure, pneumothorax, and venous thromboembolism. The same variables listed above (i.e., age, body mass index, operative time, lipoaspirate amount, and multiple procedures) were then analyzed to determine potential risk factors for inpatient admission.

Statistical analysis was performed using the nonparametric Wilcoxon rank sum test for numeric variables and Fisher's exact test for categorical variables. A difference between the variables studied was considered statistically significant for values of p < 0.05. Given that all patient information was deidentified and retrospective, consent was not obtained from the patient population.