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.

Abdominoplasty-derived dermal-fat graft augmentation gluteoplasty.

BACKGROUND: Plastic surgeons are exploring novel techniques for augmentation gluteoplasty as the demand for this procedure increases annually in the United States. OBJECTIVES: The authors retrospectively reviewed a series of lower abdominal dermal-fat graft augmentation gluteoplasties to validate the procedure. METHODS: Nine consecutive patients underwent abdominoplasty or torsoplasty in which 2 oval dermal-fat grafts were excised, de-epithelialized, and then implanted into subfascial gluteal pockets for augmentation. All operations were independently conducted by 1 of 2 surgeons at facilities in Maryland and New Jersey. RESULTS: The mean age of the 9 female patients was 46 years. The mean dermal-graft size was 188 cm(2), and the mean graft weight was 288 g. One graft became infected and required excision 39 days after the procedure. There were no other complications. All surviving grafts provided a substantial increase in posterior projection and long-lasting gluteal volume. CONCLUSIONS: Dermal-fat graft augmentation gluteoplasty provides a voluminous, natural-feeling, and durable aesthetic result. The procedure should be considered a viable option for patients undergoing abdominoplasty or torsoplasty, especially as more experience is gained. LEVEL OF EVIDENCE: 4.

Outpatient facility standards: what is necessary for satisfactory outcomes?

Patient safety is the mission of the American Association for Accreditation of Ambulatory Surgery Facilities, Inc (AAAASF). Well-crafted standards are at the foundation of attaining successful Ambulatory Surgical Facility outcomes. Without expert inspection practices and administrative processes supporting these standards, they are powerless to protect patients. This 2-part approach is used by AAAASF to ensure 100% compliance of all surgical standards.