European Journal of Plastic Surgery

, Volume 36, Issue 9, pp 573–578 | Cite as

Catastrophic outcomes are rare in outpatient plastic surgery: a multicenter analysis of 10,954 patients

  • Umang Jain
  • Nima Khavanin
  • Jennifer Cheesborough
  • John Y. S. Kim
Original Paper



Catastrophic outcomes of outpatient plastic surgery such as septic shock, myocardial infarction, and death are rare. Few studies have provided robust data on risk factors associated with these events. This study utilizes an independent, multicenter database to investigate the incidence and predictive factors of catastrophic outcomes associated with outpatient plastic surgery.


Patients in the National Surgical Quality Improvement Program (NSQIP) participant use database who underwent outpatient plastic surgery between 2006 and 2010 were identified. Demographic information for patients and rates of catastrophic outcomes within 30 days of surgery (sepsis/septic shock, pulmonary embolism, stroke, myocardial infarction (MI), cardiac arrest, coma, and death) was determined.


Over the 5-year study period, 10,954 patients underwent an outpatient plastic surgery procedure. Thirty-one patients presented with catastrophic outcomes (0.28 %). These patients had a total of 34 catastrophic outcomes: 20 sepsis/septic shock (58.8 %), 5 pulmonary embolism (14.7 %), 3 stroke (8.8 %), 2 cardiac arrest (5.9 %), and 4 death (11.7 %). No occurrences of MI or coma were reported.


Outpatient plastic surgery can be performed safely in accredited ambulatory facilities as demonstrated by the overall 0.28 % catastrophic outcome rate garnered from a 5-year review of the NSQIP database.

Level of Evidence: Level III, prognostic/risk study.


Outcomes NSQIP Catastrophic Outpatient Ambulatory 


Conflict of Interest



The American College of Surgeons National Surgical Quality Improvement Program and the hospitals participating in the ACS-NSQIP are the source of the data used herein; they have not verified and are not responsible for the statistical validity of the data analysis or the conclusions derived by the authors.

Ethical approval

De-identified patient information is freely available to all institutional members who comply with the ACS-NSQIP Data Use Agreement. The data use agreement implements the protections afforded by the Health Insurance Portability and Accountability Act of 1996 and the ACS-NSQIP Hospital Participation Agreement.


  1. 1.
    Dhumale R, Tisdale J, Barwell N (2010) Over a thousand ambulatory hernia repairs in a primary care setting. Ann R Coll Surg Engl 92:127–130PubMedCrossRefGoogle Scholar
  2. 2.
    Ford SJ, Wheeler JM, Borley NR (2010) Factors influencing selection for a day-case or 23-h stay procedure in transanal endoscopic microsurgery. Br J Surg 97:410–414PubMedCrossRefGoogle Scholar
  3. 3.
    Keyes GR, Singer R, Iverson RE et al (2008) Mortality in outpatient surgery. Plast Reconstr Surg 122:245–250, discussion 251–253PubMedCrossRefGoogle Scholar
  4. 4.
    Keyes GR, Singer R, Iverson RE et al (2004) Analysis of outpatient surgery center safety using an internet-based quality improvement and peer review program. Plast Reconstr Surg 113:1760–1770PubMedCrossRefGoogle Scholar
  5. 5.
    Liu JT, Briner RP, Friedman JA (2009) Comparison of inpatient vs. outpatient anterior cervical discectomy and fusion: a retrospective case series. BMC Surg 9:3PubMedCrossRefGoogle Scholar
  6. 6.
    Russo A, Elixhauser A, Steiner C et al (2007) Hospital-based ambulatory surgery, 2007: Statistical Brief #86. Healthcare Cost and Utilization Project (HCUP) Statistical Briefs. Agency for Health Care Policy and Research; 2006-2010Google Scholar
  7. 7.
    Iverson RE, Lynch DJ (2002) Patient safety in office-based surgery facilities: II. Patient selection. Plast Reconstr Surg 110(7):1785–1790, discussion 1791-2PubMedCrossRefGoogle Scholar
  8. 8.
    Short KK, Ringler SL, Bengtson BP et al (1996) Reduction mammoplasty: a safe and effective outpatient procedure. Aesthetic Plast Surg 20:513–518PubMedCrossRefGoogle Scholar
  9. 9.
    Dasid J, Detmer DE (1972) The ambulatory surgical unit. Ann Surg 175:856CrossRefGoogle Scholar
  10. 10.
    Davies BW, Lewis RD, Pennington GA (1996) Reduction mammoplasty: a comparison of outpatient and inpatient procedures. Aesthetic Plast Surg 20:77–80PubMedCrossRefGoogle Scholar
  11. 11.
    Detmer DE, Gelijns AC (1994) Ambulatory surgery: a more cost-effective treatment strategy? Arch Surg 129:123–127PubMedCrossRefGoogle Scholar
  12. 12.
    ISAPS International Survey on Aesthetic/Cosmetic Procedures Performed in 2011 (2012) International Society of Aesthetic Plastic Surgery. Accessed 1 January 2013
  13. 13.
    2011 Plastic Surgery Statistics Report (2012) American Society of Plastic Surgeons. Accessed 1 January 2013
  14. 14.
    Engbaek J, Bartholdy J, Hjortso NC (2006) Return hospital visits and morbidity within 60 days after day surgery: a retrospective study of 18,736 day surgical procedures. Acta Anaesthesiol Scand 50:911–919PubMedCrossRefGoogle Scholar
  15. 15.
    Natof HE (1980) Complications associated with ambulatory surgery. JAMA 244:1116–1118PubMedCrossRefGoogle Scholar
  16. 16.
    Mezei G, Chung F (1999) Return hospital visits and hospital readmissions after ambulatory surgery. Ann Surg 230:721–727PubMedCrossRefGoogle Scholar
  17. 17.
    Stevens WG, Gear AJ, Stoker DA et al (2008) Outpatient reduction mammoplasty: an eleven-year experience. Aesthet Surg J 28(2):171–179PubMedCrossRefGoogle Scholar
  18. 18.
    Stevens WG, Repta R, Pacella SJ et al (2009) Safe and consistent outcomes of successfully combining breast surgery and abdominoplasty: an update. Aesthet Surg J 29(2):129–134PubMedCrossRefGoogle Scholar
  19. 19.
    Buenaventura S, Severinac R, Mullis W et al (1996) Outpatient reduction mammoplasty: a review of 338 consecutive cases. Ann Plast Surg 36:162–166PubMedCrossRefGoogle Scholar
  20. 20.
    Scott GR, Carson CL, Borah GL (2005) Maximizing outcomes in breast reduction surgery: a review of 518 consecutive patients. Plast Reconstr Surg 116:1633–1639, discussion 1640-1641PubMedCrossRefGoogle Scholar
  21. 21.
    User guide for the 2010 Participant use Data File (2011) American College of Surgeons National Surgical Quality Improvement Program Web site. Accessed 1 December 2012
  22. 22.
    Birkmeyer JD, Shahian DM, Dimick JB et al (2008) Blueprint for a new American College of Surgeons: national surgical quality improvement program. J Am Coll Surg 207:777–782PubMedCrossRefGoogle Scholar
  23. 23.
    Rowell KS, Turrentine FE, Hutter MM et al (2007) Use of national surgical quality improvement program data as a catalyst for quality improvement. J Am Coll Surg 204:1293–1300PubMedCrossRefGoogle Scholar
  24. 24.
    Ogunleye AA, de Blacam C, Curtis MS et al (2012) An analysis of delayed breast reconstruction outcomes as recorded in the American College of Surgeons National Surgical Quality Improvement Program. J Plast Reconstr Aesthet Surg 65(3):289–294PubMedCrossRefGoogle Scholar
  25. 25.
    Pannucci CJ, Shanks A, Moote MJ et al (2012) Identifying patients at high risk for venous thromboembolism requiring treatment after outpatient surgery. Ann Surg 225(6):1093–1099CrossRefGoogle Scholar
  26. 26.
    Shabbir J, Ridgway PF, Shields W et al (2006) Low molecular weight heparin prophylaxis in day case surgery. Ir J Med Sci 175:26–29PubMedCrossRefGoogle Scholar
  27. 27.
    Leonard F, Lecuru F, Rizk E et al (2000) Perioperative morbidity of gynecological laparoscopy. Acta Obstet Gynecol Scand 79:129–134PubMedCrossRefGoogle Scholar
  28. 28.
    Cook JL, Perone JB (2003) A prospective evaluation of the incidence of complications associated with Mohs micrographic surgery. Arch Dermatol 139(2):143–152PubMedCrossRefGoogle Scholar
  29. 29.
    Berger RA, Walsh SM (2009) Outpatient total knee arthroplasty: pathways and protocols. Tech Knee Surg 8(2):115–118CrossRefGoogle Scholar
  30. 30.
    Haynes AB, Weiser TG, Berry WR et al (2009) A surgical safety checklist to reduce morbidity and mortality in a global population. N Engl J Med 360:491–499PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Umang Jain
    • 1
  • Nima Khavanin
    • 1
  • Jennifer Cheesborough
    • 1
  • John Y. S. Kim
    • 1
  1. 1.Division of Plastic and Reconstructive Surgery, Feinberg School of MedicineNorthwestern UniversityChicagoUSA

Personalised recommendations