Study shows tumescent liposuction safe, effective
Study offers patient satisfaction, benchmarks
More than 372,000 patients underwent liposuction in 2002, making it the most commonly performed aesthetic procedure, according to statistics recently released by the New York City-based American Society for Aesthetic Plastic Surgery.1
Because of liposuction’s popularity and questions about the safety of the procedure,2 the Accreditation Association for Ambulatory Health Care’s (AAAHC) Institute for Quality Improvement (IQI) in Wilmette, IL, conducted a study of tumescent liposuction to compare practices and results of the surgery.
"We focused upon tumescent liposuction in which local anesthesia alone was used so we could compare similar procedures and settings," says Naomi Kuznets, PhD, director of the IQI. Liposuction under general anesthesia is being addressed in a separate IQI study, Kuznets says.
The most notable finding is confirmation of the belief that tumescent liposuction is safe, says C. William Hanke, MD, president of the AAAHC board of directors and medical director of the Laser and Skin Surgery Center in Carmel, IN.
"Many retrospective studies have demonstrated the safety of this procedure, but ours is the first real-time study to prove it," Hanke says. The information in the study will be helpful for same-day surgery programs to evaluate their own practice related to tumescent liposuction, he adds.
Of the 702 cases collected from 39 participating organizations, complications were reported in only 14 cases. Complications were generally minor and included hematoma (3), extreme discomfort (2), hyperpigmentation (2), anxiety (1), dizziness (1), mild swelling (1), hypotension (1), and sensitivity to epinephrine (1). In one case, a power outage interrupted the procedure. The most severe complication was a hospitalization to rule out a pneumothorax. Once complications that were not directly associated with the liposuction procedure, such as anxiety or dizziness, were eliminated, the clinical complication rate was 0.7%, Kuznets says.
"I was very surprised to see a pneumothorax reported in the study," says Sue Ellen Cox, MD, a dermatologic surgeon in Chapel Hill, NC. Because this study involved liposuction patients who were awake, an injury of this severity is unusual, Cox says. "When I rub a muscle with the cannula, my patients say ouch,’" she says. An injury such as a pneumothorax is more likely to occur when the patient is asleep, she adds.
Another safety issue to consider in tumescent liposuction is total lidocaine dose, Cox says.
From the information provided by the study participants, IQI calculated the total lidocaine dose for 513 cases, she says. Body weight values, lidocaine concentration values, or infused fluid volume were not available for the other cases.
"We found that one-third were incorrectly calculated by the organizations submitting data," Cox says.
The information about the incorrect lidocaine doses raises questions about who is calculating the dose, what type of training is given, and how much physician oversight of the calculation and the data collected in the study existed, Kuznets says.
While the American Academy of Dermatology in Schaumburg, IL, has cited 55mg/kg as a safe limit for total lidocaine dose in liposuction, 8% of the cases in the IQI study exceeded this limit, says Cox. Forty-six percent of the cases were below the more conservative limit of 35 mg/kg cited in clinical guidelines produced by the American Society of Plastic Surgeons in Arlington Heights, IL.
(Editor’s note: The maximum dose of 55 mg/kg recommended by the American Academy of Dermatology applies to the tumescent technique only. For other techniques, the guidelines are 4.5 mg/kg to a maximum of 300 mg without epinephrine and 7 mg/kg to a total of 500 mg with epinephrine.)
For all but 12 cases or 2% of total cases submitted, prophylactic antibiotics were used. "I prescribe 1 g of cefazolin preoperatively and cephalexin for one week following surgery," says Cox. "I choose to treat potential infection aggressively, but not all physicians prescribe antibiotics following surgery."
"We did measure procedure and discharge times in the same way we’ve measured them in previous studies," says Kuznets.
A slight change was made in the measurement of wait time rather than pre-procedure time, she says. Wait time is a combination of how long before the procedure was scheduled that the patient was shown into the OR and the time the patient was shown in the OR to the time when infiltration began. The average wait time ranged from 13 to 91 minutes, with a median of 32 minutes. "As with all other studies, wait time is affected by how early the patient is instructed to arrive," adds Kuznets.
In addition to procedure time, which is defined as the insertion of the cannula to the time the cannula is removed, the IQI study also gathered information on infusion/diffusion time. Infusion/ diffusion time is defined as the time infiltration is started to the procedure start time. Infusion/diffusion time ranged from 25 minutes to 193 minutes, with a median of 70 minutes. Procedure times ranged from 28 to 153 minutes with a median of 87 minutes.
"Procedure time statistics may not be as beneficial as they’ve been in previous studies because there was a great variation in the types of procedures performed," says Kuznets. "We also found that many cases combined several liposuction procedures," she adds.
The most common liposuction procedures were performed on the following body areas:
- thigh, 30%;
- abdomen, 23%;
- hip, 22%.
Patients included in the study received follow-up phone calls to measure their satisfaction at one-, three-, and six-month intervals, says Kuznets.
At six months post-surgery, 84% of patients were very satisfied (55%) and "nearly" very satisfied (29%) with the results of surgery, she says. In terms of discomfort during procedure, 75% had a rating of 1 or 2, with 1 representing no discomfort on a scale of 1 to 5, says Kuznets. Slightly more than 1% rated their discomfort level as severe discomfort, she adds.
Being able to follow up with patients in real time is a great advantage, points out Hanke.
"This study shows that tumescent liposuction is safe, patients experience little discomfort during and after the procedure, and patients are very satisfied with the results," he says.
Resources
For more on the study, contact:
• Naomi Kuznets, PhD, Director, AAAHC Institute for Quality Improvement, 3201 Old Glenview Road, Suite 300, Wilmette, IL 60091-2992. Telephone: (847) 853-6060, ext.179. Fax: (847) 853-9028. E-mail: [email protected].
• Sue Ellen Cox, MD, Cosmetic Surgery of North Carolina, 5925 Farrington Road, Chapel Hill, NC 27517. Telephone: (919) 682-2901.
Copies of the Tumescent Liposuction Study are $25 each. To order, contact:
• Institute for Quality Improvement, 3201 Old Glenview Road, Suite 300, Wilmette, IL 60091-2992. Telephone: (847) 853-6060. Web: www.aaahciqi.org.
References
1. American Society for Aesthetic Plastic Surgery. 2002 Cosmetic Surgery Statistics. Los Alamitos; CA.
2. Coldiron B. Office surgical incidents: 19 months of Florida data. Dermatol Surg 2002; 28:710-713.
Because of liposuctions popularity and questions about the safety of the procedure,2 the Accreditation Association for Ambulatory Health Cares Institute for Quality Improvement in Wilmette, IL, conducted a study of tumescent liposuction to compare practices and results of the surgery.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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