Quantifying the Crisis: Opioid-Related Adverse Events in Outpatient Ambulatory Plastic Surgery.

BACKGROUND: The United States is currently in the midst of an opioid epidemic precipitated, in part, by the excessive outpatient supply of opioid pain medications. Accordingly, this epidemic has necessitated evaluation of practice and prescription patterns among surgical specialties. The purpose of this study was to quantify opioid-related adverse events in ambulatory plastic surgery. METHODS: A retrospective review of 43,074 patient profiles captured from 2001 to 2018 within an American Association for Accreditation of Ambulatory Surgery Facilities quality improvement database was conducted. Free-text search terms related to opioids and overdose were used to identify opioid-related adverse events. Extracted profiles included information submitted by accredited ambulatory surgery facilities and their respective surgeons. Descriptive statistics were used to quantify opioid-related adverse events. RESULTS: Among our cohort, 28 plastic surgery patients were identified as having an opioid-related adverse event. Overall, there were three fatal and 12 nonfatal opioid-related overdoses, nine perioperative opioid-related adverse events, and four cases of opioid-related hypersensitivities or complications secondary to opioid tolerance. Of the nonfatal cases evaluated in the hospital (n = 17), 16 patients required admission, with an average 3.3 ± 1.7 days' hospital length of stay. CONCLUSIONS: Opioid-related adverse events are notable occurrences in ambulatory plastic surgery. Several adverse events may have been prevented had different diligent medication prescription practices been performed. Currently, there is more advocacy supporting sparing opioid medications when possible through multimodal anesthetic techniques, education of patients on the risks and harms of opioid use and misuse, and the development of societal guidance regarding ambulatory surgery prescription practices.

Minimal incision brachioplasty: refining transaxillary arm rejuvenation.

In minimal incision brachioplasty, surgical rejuvenation of the arms is achieved with incisions limited to the axilla. When needed, lipoplasty is added to surgical resection of skin and axillary tissue. The authors contend that minimal incision brachioplasty is safe and effective with predictable, reproducible, and long-lasting results.

Brachioplasty with limited scar.

There is a growing interest in upper arm aesthetic surgery but many patients do not accept the visible inner arm scar. Minimal incision brachioplasty using a shorter scar, concealed in the axilla, produces results equal to that of the traditional approach in comparable cases. Patients with massive weight loss may not meet the criteria for surgery. Patient selection and careful preoperative markings are critical to the success of the procedure. The author describes the technique he has been using for more than 30 years along with refinements. Minimal incision brachioplasty is an alternative to the traditional long scar approach in selected patients. It is a less involved procedure, with a low complication rate and high patient satisfaction.