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Plast Reconstr Surg Glob Open
Plast Reconstr Surg Glob Open
GOX
Plastic and Reconstructive Surgery Global Open
2169-7574
Lippincott Williams & Wilkins Hagerstown, MD

GOX-D-24-00774
00040
10.1097/01.GOX.0001063968.86880.30
3
PSTM Abstract Supplement
PSTM Top Abstracts/Posters 2024
Three Decades of Outpatient Plastic Surgery Safety: A Review of 42,720 Consecutive Cases
Rohrich Rachel BS 1
Brown Tal BS 1
Brown Stav MD 1
Burns John MD 1
Meade Ricardo MD 1
Jejurikar Sameer MD 1
Rohrich Rod MD 1
Washington, DC
9 2024
18 9 2024
12 Suppl 31Copyright © 2024 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The American Society of Plastic Surgeons. All rights reserved.
2024
https://creativecommons.org/licenses/by-nc-nd/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

OPEN-ACCESSTRUE
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pmcBACKGROUND: Outpatient plastic surgery offers cost-effective solutions and enhanced privacy but demands careful patient assessment for suitability and vigilant anticipation of adverse events. This study provides recommendations to maximize patients’ safety in the outpatient setting considering both patient- and procedure-specific factors, by analyzing over 40,000 consecutive cases spanning across three decades of clinical experience.

METHODS: We retrospectively reviewed all consecutive cases completed by board-certified plastic surgeons at an accredited outpatient surgical center between 1995-2023. Patient demographics, operative details, and postoperative complications were recorded to determine both patient- and procedure-specific risk factors for complications and inpatient admissions. Operative details included total operative-time, lipoaspirate amount, and whether the procedure was a combined case. Complications included hematoma, seroma, wound-dehiscence, infection, and venous thromboembolic events (VTE). Additionally, we collected complications that required return to the operating room (ROR) and admission to an inpatient facility. Continuous variables were compared using a student t-test and logistic regressions were utilized to assess the predictive value of variables. Receiver operating characteristic (ROC) curves were created for each variable and the Youden’s method was used to determine the optimal cutoff points. A subgroup-analysis for procedures of the face, breast and body was also performed.

RESULTS: 42,720 consecutive cases were performed with an overall complication rate of 0.74 percent (n = 318). Compared with the control population, patients who experienced a VTE or an inpatient transfer, had a higher BMI (p < 0.001; p < 0.0001, respectively), longer operative duration (p = 0.0024; p = 0.0012, respectively) and were more likely to have undergone combined procedures (p < 0.001; p = 0.0001, respectively). Undergoing a combined procedure was the strongest predictive factor for VTE and inpatient admissions (OR = 12.65, p = 0.0009; OR = 3.73, p = 0.0002, respectively), followed by longer operative time (OR = 1.45, p = 0.006; OR = 1.32, p = 0.003, respectively).

CONCLUSION: To our knowledge, this is the largest long-term private practice plastic surgery study in accredited outpatient settings spanning almost 30 years, further confirming that outpatient plastic surgery can be done in a consistent and safe manner with proper preoperative evaluation and patient optimization. Postoperative monitoring should be considered for high-risk patients, particularly those with a BMI exceeding 26 kg/m², operative times surpassing 3 hours, lipoaspirate volumes greater than 3 liters, and patients undergoing combined procedures - particularly in cases involving abdominoplasty.
