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. Some states, among them Pennsylvania and Tennessee, have mandated that surgeries longer than four hours be performed in an inpatient facility.

Neil Gordon, M.D., clinical instructor in the Department of Surgery, said there is little data on which regulatory bodies can base these types of decisions. Defining the associated risk is important, he said, because the entire face must be treated as a unit, requiring multiple procedures and longer surgeries.

He and his co-author, Mark Koch, M.D., State University of New York at Stony Brook, evaluated 1,200 patients who had undergone facial plastic surgery. Of those, 1,032 were under anesthesia for more than four hours. Most of the patients in the group receiving longer anesthesia underwent multiple facial procedures, while most in the group receiving shorter anesthesia only had plastic surgery on the nose (rhinoplasty).

Gordon said no deaths were reported the day after surgery and the rate of complications was similar regardless of the duration of anesthesia. Of the 1,200 patients, only three, among them one receiving shorter anesthesia, developed major complications, including respiratory failure, nervous system deficit, and an adverse reaction to medication, he said.

"When regulatory bodies consider creating surgical guidelines, a detailed understanding of specific risks associated with different types of surgery is needed to avoid generalization and inappropriate, non-data driven regulation," Gordon said.

Archives of Facial Plastic Surgery 8: 47-53 (January/February 2006)

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