This was a study of 129,000 patients. (yes. 129 thousand) looking at surgical site infections. It was a prospective study from 2008-2013. They looked at infections which required a trip to the ER, hospital admission, or reoperation within 30 days.
Why? They wanted to find out what risk factors caused these infections. Is it BMI? Smoking? Diabetes? Age?
“Incidence and Risk Factors for Major Surgical Site Infections in Aesthetic Surgery: Analysis of 129,007 patients.” January 2017 Aesthetic Surgery Journal.
The CDC states the rate of infection for skin surgery (not intraabdominal) is 2-5%. This study was done to see if plastic surgery rates differ. To find this, you need large numbers of patients. Hence this study. The enrollment was done via the CosmetAssure insurance program. (This program is available to board certified plastic surgeons, and is an insurance program for any complication from cosmetic surgery procedures. Anyone at a participating practice having any procedure must be enrolled.) Any issue which was managed in the clinic only was not included as a complication.
Study
- 129000 patients
- 24 unique surgical procedures, with different combinations of those procedures
- combined procedure: more than one of the above
Findings:
- mean age 41
- BMI 24
- 93% women, 7% men
- active smokers: 8%
- self reported diabetes 2%
- COMPLICATIONS
- 2% overall rate, 0.46% were infections (hematoma was a the largest complication)
- Older (age 43.8)
- higher BMI (27.3)
- smokers
- preexisting diabetes
- higher infections in accredited surgery centers and hospitals, (rather than in office)
- multiple procedures
- body procedures (not breast or face)
Thoughts?
Always good to have data, and this is a large prospective study. The reassuring thing for those looking at this is the incidence of any complication was low (2%), and for infection it was less than half a percent. (Please remember CosmetAssure is only for board certified plastic surgeons, so the surgical technique and sterility may be higher than for those who call themselves “plastic surgeon” but were trained in residency in non surgical areas.)
There are always differences in how people prep their patients. I have my patients use surgical scrub for days ahead of surgery to help lower the risk of infection. Clipping hair (not shaving) has been shown to decrease infection rates. Timing of IV antibiotics before surgery also lowers the risk.
Combined procedures which include the abdomen (liposuction or tummy tuck) and longer procedure times have been known to increase rates of complication and infection. This study supports that.
This study also supports smokers, diabetics, higher BMI patients have higher risk. That is known as well.
This study supports avoiding the large hospital centers to do elective procedures. This is known, and thought to be due to sick people are in bigger hospitals. Sick people mean more bacteria and possible drug resistant varieties.
So again, good to have such a large study of data. It supports a lot of what we know.