Several high-profile patient deaths in office-based plastic surgery facilities have led state regulatory agencies and medical boards to develop policies regarding the procedures performed at these locations, according to background information in the article. Some, including those in Pennsylvania and Tennessee, have mandated that any surgeries longer than four hours (240 minutes) be performed in an inpatient facility. However, there is little data on which regulatory bodies can base these types of decisions, the authors write. "Defining the risks and morbidity related to longer procedure duration, specifically in facial plastic surgery, has great significance because of the necessity to treat the aging face as a unit, thus appropriately combining multiple procedures" that will require longer surgeries, they report.
Neil A. Gordon, M.D., Yale University School of Medicine, New Haven, Conn., and Marc E. Koch, M.D., State University of New York at Stony Brook, evaluated 1,200 patients who had undergone facial plastic surgery between July 1995 and February 2005. Of those, 1,032 (86 percent) were under anesthesia for more than 240 minutes. Most of the patients in the longer anesthesia group underwent multiple facial procedures, while most in the shorter anesthesia group had only rhinoplasty (plastic surgery on the nose). All of the procedures were performed by a board-certified surgeon; 1,008 of them were performed by Dr. Gordon, accompanied by board-certified anesthesiologists.
Each participant was monitored the day after the surgery. No deaths were reported in the study and the rate of complications was similar in both groups. Three patients overall--one in the
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