National Mortality Rates After Outpatient Cosmetic Surgery and Low Rates of Perioperative Deep Vein Thrombosis Screening and Prophylaxis

Background: Concerns have arisen over reports of deaths occurring after certain outpatient plastic surgery procedures. Here, we present a detailed analysis of the American Association for the Accreditation of Ambulatory Surgical Facilities (AAAASF) database and report on deaths occurring after outpatient cosmetic surgical procedures, causative factors, and venous thromboembolism (VTE) screening rates. Methods: A retrospective analysis of the AAAASF database was performed for the years 2012-2017. We retrieved data for all deaths occurring in association with cosmetic plastic surgery procedures. Patient demographics, procedural data, VTE risk factor assessment, and cause of death were analyzed. De-identified medical records, including coroner's reports, were reviewed where available. Results: Data for 42 deaths were retrieved. Of these, 90.5% (n=38) were female, and 61.9% were Caucasian (n=26). Mean age was 51.6 years (standard deviation, SD ±14.8), while mean BMI was 29.5kg/m2 (SD ±5.5). Overall, 54.8% of these deaths occurred after abdominoplasty: 42.9% in isolation, 9.5% in combination with breast surgery, and 2.4% with facial surgery. Of the causes of death, most (38.1%) were thromboembolic in origin. Notably, in 25 of 42 cases, VTE risk factor assessment was incorrect or absent (59.5%). Conclusions: Accreditation agencies provide transparency and insight into outpatient surgical mortality on a national scale. Results suggest that adoption of venous thromboembolism screening techniques may not be universal despite an existing large body of published evidence. Optimization of thromboembolism prevention pathways remains vital, and consideration of anticoagulation in those undergoing abdominoplasty may be important in lowering outpatient mortality. Financial Disclosures: Dr. Gary Brownstein, Dr. Lawrence Reid, and Dr. David Watts are on the Executive Committee for the American Association for Accreditation of Ambulatory Surgery Facilities and receive an annual stipend. None of the remaining authors has a financial interest in any of the products, devices, or drugs mentioned in this manuscript. Correspondence may be directed to: Samuel J Lin, MD, MBA, 110 Francis St., Suite 5A, Boston, MA 02215, Tel: 617-632-7369, sjlin@bidmc.harvard.edu David Watts, MD, American Association for Accreditation of Ambulatory Surgery Facilities, Gurnee, Illinois, Tel. 856-691-0200, dwatts@aaaasf.org ©2018American Society of Plastic Surgeons