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Is A Medical Spa The Right Place For Invasive Surgery?
A recent article in The New York Times Style section relayed the unfortunate death of a young nurse as a result of a misguided liposuction procedure in a "medical spa".
Invariably, every year or so, a similar tragedy comes to awareness. Typically, a patient undergoes a surgical procedure in an environment which does not meet the minimum safety standards.
Often patients underestimate the complexity and potential hazards of any surgical procedure regardless of how anatomically superficial it may be. Yes, liposuction involves only suctioning that layer of fat directly under the skin. And, yes, no major body cavity, such as the chest or abdomen is entered.
In the Florida case discussed in the New York Times, the liposuction was performed and local anesthesia was used. Even just local anesthesia has hazards. Unlike a dentist's office where local anesthesia is used in very small volumes, perhaps just several cc's, liposuction usually calls for large volumes of the anesthetic solution with added epinephrine to increase the duration of the anesthetic and to reduce tissue bleeding. But both types of medications, local anesthetics and the epinephrine class of drugs, can have an effect on the heart. Should the medication be absorbed too quickly or should too-strong a concentration be formulated, then the risk of untoward reaction increases.
There are two issues which every patient needs to understand with respect to surgery. First, there is always the potential for problems and the best insurance against having a catastrophic outcome is to have the procedure performed in a fully equipped surgical facility. A medical spa is not a bona fide surgical facility.
The facility should be either licensed by the state, accredited by the United States Department of Health and Human Services (accredits facilities to qualify for Medicare payments) , or by one of three well-known private accrediting organizations: Accreditation Association for Ambulatory Health Care (AAAHC) , the American Association for Accreditation of Ambulatory Surgical Facilities(AAAASF) and the Joint Commission on Accreditation of Health Care Organizations (JCAHO), which accredits hospitals. Fully accredited, licensed facilities must have the same resuscitative equipment, emergency drugs and supplies and infection control standards as a hospital. They have passed the test.
Finally, I would never have any type of significant surgical procedure, whether done under local anesthesia or with local anesthesia with sedation or general anesthesia, without the services of a board certified physician anesthesiologist. Certified Registered Nurse Anesthetists (CRNAs) may be appropriate in some situations. In any event, you want an anesthesia specialist at the controls. Such specialists are another "insurance policy" for you because they will not work in a substandard facility.
Yes, there is some added cost to have an anesthesia specialist on your side and at your side. But, the incremental cost in having such specialist is very reasonable. After all, what is your comfort, safety - and even your life - worth?
- Robert Kotler, MD, FACS
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Invariably, every year or so, a similar tragedy comes to awareness. Typically, a patient undergoes a surgical procedure in an environment which does not meet the minimum safety standards.
Often patients underestimate the complexity and potential hazards of any surgical procedure regardless of how anatomically superficial it may be. Yes, liposuction involves only suctioning that layer of fat directly under the skin. And, yes, no major body cavity, such as the chest or abdomen is entered.
In the Florida case discussed in the New York Times, the liposuction was performed and local anesthesia was used. Even just local anesthesia has hazards. Unlike a dentist's office where local anesthesia is used in very small volumes, perhaps just several cc's, liposuction usually calls for large volumes of the anesthetic solution with added epinephrine to increase the duration of the anesthetic and to reduce tissue bleeding. But both types of medications, local anesthetics and the epinephrine class of drugs, can have an effect on the heart. Should the medication be absorbed too quickly or should too-strong a concentration be formulated, then the risk of untoward reaction increases.
There are two issues which every patient needs to understand with respect to surgery. First, there is always the potential for problems and the best insurance against having a catastrophic outcome is to have the procedure performed in a fully equipped surgical facility. A medical spa is not a bona fide surgical facility.
The facility should be either licensed by the state, accredited by the United States Department of Health and Human Services (accredits facilities to qualify for Medicare payments) , or by one of three well-known private accrediting organizations: Accreditation Association for Ambulatory Health Care (AAAHC) , the American Association for Accreditation of Ambulatory Surgical Facilities(AAAASF) and the Joint Commission on Accreditation of Health Care Organizations (JCAHO), which accredits hospitals. Fully accredited, licensed facilities must have the same resuscitative equipment, emergency drugs and supplies and infection control standards as a hospital. They have passed the test.
Finally, I would never have any type of significant surgical procedure, whether done under local anesthesia or with local anesthesia with sedation or general anesthesia, without the services of a board certified physician anesthesiologist. Certified Registered Nurse Anesthetists (CRNAs) may be appropriate in some situations. In any event, you want an anesthesia specialist at the controls. Such specialists are another "insurance policy" for you because they will not work in a substandard facility.
Yes, there is some added cost to have an anesthesia specialist on your side and at your side. But, the incremental cost in having such specialist is very reasonable. After all, what is your comfort, safety - and even your life - worth?
- Robert Kotler, MD, FACS
Get the WebMD Skin & Beauty Newsletter - tips to look good and feel great.
Labels: anesthesia, cosmetic surgery
2 Comments:
This case is a disaster. How did a well-educated nurse not know better? The doctor was not a Board Certified Plastic Surgeon; the facility was clearly inappropriate; the technique was not standardized; etc.
To the public, I implore you all to do your homework before embarking on cosmetic surgery. These procedures are major, and you need to be sure that the doctor really knows what he is doing. When money is a motivator, good sense can be forgotten, even by doctors.
I think a doctor's office is the correct place for invasive surgery, not a medical spa. I would never trust my body to someone at a medical spa--I always want to know that I'm well cared for by medical staff.
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