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General anesthesia, combo procedures boost risk


Cincinnati — Use of general anesthesia, performance of liposuction under general anesthesia, and combining surgical procedures significantly increase the risk for adverse events (AEs) in office-based surgery, a new review suggests.

A review of mandatory adverse-event reporting, derived from 10-year data from Florida and six-year data from Alabama, “confirms trends that have been previously identified in earlier analyses of this data,” wrote lead author John Starling III, M.D, of the University of Cincinnati’s department of dermatology.

Medscape Today reports that according to the study, which appears in the February issue of Dermatologic Surgery, more than two-thirds of deaths and three-quarters of hospital transfers were associated with cosmetic surgery performed under general anesthesia.

The study is especially critical of liposuction performed under general anesthesia, noting that while liposuction is one of the most common cosmetic procedures, no deaths occurred with local anesthesia. “Liposuction under general anesthesia accounted for 32 percent of cosmetic procedure-related deaths and 22 percent of all cosmetic procedure-related complications,” the researchers wrote.

In the Florida statistics, a total of 309 AEs were reported during office-based surgery, including 46 deaths and 263 reportable complications or transfers to hospital. Cosmetic surgeries performed under general anesthesia accounted for the vast majority of deaths in Florida, with liposuction and abdominoplasty the most frequently reported procedures.

In the Alabama data, 52 AEs were reported, including 49 complications or hospital transfers and three deaths. General anesthesia was implicated in 89 percent of reported incidents, of which 42 percent were cosmetic surgeries. Pulmonary complications, including pulmonary emboli and pulmonary edema, were implicated in many deaths in both states.

The authors noted one limitation in their study, which was that case logs of procedures performed under general and intravenous sedation are required in Florida, but are not in the public domain and so were unavailable for analysis. Also, researchers were unable to obtain data on the total number of liposuction procedures performed in either state, which prevented them from calculating the overall fatality rate.

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