The use of general anesthesia in conjunction with cosmetic surgery (e.g. liposuction) has been shown to significantly increase the risk for adverse events in office-based surgery. The new data published in the February issue of Dermatologic Surgery, 2012 (Dermatol Surg. 2012;38:171-179) states that two-thirds of deaths and three-quarters of hospital transfers were performed under general anesthesia as opposed to local anesthesia.

The study, derived from 10-year data from Florida and 6-year data from in Alabama, “confirms trends that have been previously identified in earlier analyses of this data,” write the authors, led by John Starling III, MD, from the Skin Cancer Center, Cincinnati, and the Department of Dermatology, University of Cincinnati, Ohio.

309 adverse events were reported in Florida, consisting of 46 deaths and 263 complications or hospital transfers, the majority of these as a result of cosmetic surgery done under general anesthesia. In Alabama, 52 adverse events were reported, consisting of 3 deaths and 49 complications or hospital transfers. 89% of these had a causal link to general anesthesia, and 42% were cosmetic surgeries. Pulmonary complications, including pulmonary emboli and pulmonary edema, were implicated in many deaths in both states.

Plastic surgeons were linked to nearly 45% of all reported complications in Florida and 42.3% in Alabama, write the researchers. No clear correlation was seen in regards to office accreditation, board certification, or hospital privileges.

According to commentary from C. William Hanke, MD, of the Laser and Skin Surgery Center of Indiana, three patient safety practices he recommends are “(1) Keep the patient awake!… 2) Think twice before supporting a patient’s desire for liposuction that is to be done in conjunction with abdominoplasty under general anesthesia…. 3) [B]e advocates for prospective, mandatory, verifiable adverse event reporting…[that] should include data from physician offices, ambulatory surgical centers, and hospitals to define and quantify problems that can be largely prevented and eliminated.”

The authors and editorialist were especially critical of liposuction done under general anesthesia. “No deaths occurred in the setting of local anesthesia. Liposuction under general anesthesia accounted for 32% of cosmetic procedure-related deaths and 22% of all cosmetic procedure-related complications,” the researchers write.

Dermatol Surg. 2012;38:171-179. Article abstract, Commentary extract.