Elsevier

Dermatologic Clinics

Volume 17, Issue 4, 1 October 1999, Pages 899-902
Dermatologic Clinics

MORBIDITY AND MORTALITY RELATED TO LIPOSUCTION: Questions and Answers

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Tumescent Anesthesia

This technique of local anesthesia, developed by dermatologist Jeffrey Klein, uses relatively large volumes of dilute lidocaine and epinephrine for liposuction totally under local anesthesia without significant blood loss.8, 10, 11 Tumescent anesthesia has also been used for other procedures such as hair transplantation, dermabrasion, laser resurfacing, and vein surgery. General anesthesia and intravenous sedation are not necessary when tumescent anesthesia is used. The tumescent anesthetic

HOW MANY LIPOSUCTION FATALITIES HAVE OCCURRED IN THE UNITED STATES?

Statistics on this question are difficult to obtain. Plastic surgeons Grazer and de Jung7 collected fatality data from 1200 board-certified plastic surgeons. A total of 867 plastic surgeons (76%) responded to the survey questionnaire. The survey revealed 130 fatalities from liposuction in the United States since 1993. The top ten states for fatalities were California (16), New York (10 to 15), Florida (16), Arizona (6), Georgia (5 to 6), Nevada (5 to 6), Texas (5 to 6), Minnesota (3), and North

WHAT ARE THE RISK FACTORS IN LIPOSUCTION FATALITY CASES AND WHAT HAVE BEEN THE CAUSES OF THESE FATALITIES?

A number of features are present in many of the fatalities that have been reported:

  • 1

    The cases were nearly always performed under general anesthesia or intravenous sedation.

  • 2

    The cases involved multiple surgeries (in addition to liposuction) being performed during the same operative session.

  • 3

    High-volume liposuction (> 5000 mL of fat aspirated) was performed.

  • 4

    Many of the fatalities occurred even when the liposuction surgery was performed in the hospital.

  • 5

    In an attempt to maximize fat removal,

DOES BOARD CERTIFICATION GUARANTEE SAFETY FOR PATIENTS UNDERGOING LIPOSUCTION?

Gorney reported that board certification does not protect a physician from complications.7 Liability insurance data demonstrated that board-certified plastic surgeons did not have a lower claim rate than nonboard-certified plastic surgeons. Similarly, Grazer and de Jung's survey data demonstrated that board-certification does not guarantee that serious complications will not occur.7 The Sun-Sentinal concluded from their investigation of plastic surgery complications that “liposuction is only as

DOES THE VENUE (HOSPITAL, AMBULATORY SURGERY CENTER, OFFICE SURGICAL FACILITY) GUARANTEE PATIENT SAFETY?

Data from the Physicians Insurance Association of America (PIAA) Data Sharing Project for 1995 to 1997 indicated that 71% of liposuction claims occurred when liposuction was performed in a hospital setting.1 In contradistinction, 21% of claims occurred when liposuction was performed in an office surgical facility.

WHAT IS CURRENTLY BEING DONE ABOUT THE LIPOSUCTION FATALITY PROBLEM?

On June 20, 1998, the Plastic/Cosmetic Surgery Committee of the California Medical Board held a hearing in Los Angeles, to investigate the liposuction fatality problem. Representatives from the specialty societies, specialty boards, insurance companies, accreditation agencies, the public, and the media were invited. Fact finding included presentations by national specialty boards and societies, the ACGME, the ABMS, malpractice insurance companies, and accreditation agencies. The conclusions of

WHAT QUESTIONS SHOULD A PROSPECTIVE PATIENT ASK THE DOCTOR ABOUT LIPOSUCTION?

  • A

    Is the doctor board certified in their specialty?

  • B

    What is the doctor's training and experience in liposuction?

  • C

    How long has the doctor been performing liposuction and how many patients has he or she treated?

  • D

    Does the doctor perform liposuction under local anesthesia or general anesthesia?

  • E

    Does the doctor perform tumescent liposuction with the patient totally awake?

  • F

    Has the doctor personally had any serious liposuction complications or fatalities?

  • G

    If complications occurred, how did the doctor

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References (12)

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    Does the location of the surgery or the specialty of the physician affect malpractice claims in liposuction?

    Dermatol Surg

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    Current practice standards in liposuction

    American Journal of Cosmetic Surgery

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    Liposuction: A practitoiner profile

    American Journal of Cosmetic Surgery

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  • R.F. Jackson et al.

    Liposuction and patient safety

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    (1999)
There are more references available in the full text version of this article.

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