|
Liposuction Procedures: How, Not WhereThe American Academy of Dermatology (AAD) believes that the issue in office-based medicine is how, not where, some doctors are performing certain surgical procedures (Elizabeth Lapetina and Elizabeth Armstrong, July/Aug 02). The AAD is concerned about the assertion that "aesthetic plastic surgeons...are the specialty most qualified to perform liposuction procedures." Dermatology is the only specialty that includes liposuction training in its residency requirements. Tumescent liposuction, which uses local anesthesia administered with controlled volumes of fluid, was developed by a dermatologist to maximize patient safety.As the first medical specialty organization to develop guidelines of care for liposuction, the AAD recommends that liposuction should not be performed under general anesthesia, should be performed on healthy people, is not a procedure to treat obesity, should not be used to extract large amounts of fat, and should not be performed along with other procedures. Contrary to the authors’ assertions, data reviewed in a letter to the Journal of the American Medical Association showed that adverse incidents occur during office-based procedures when the above guidelines are not followed.1 We also remind the authors that the AAD’s recommendations for lidocaine usage are within the range of safely recommended dosages for anesthesia during this procedure. The Food and Drug Administration’s maximum dosage for regional anesthesia was sanctioned in 1947, well before the development of tumescent liposuction, and has not been updated since. We share the researchers’ concern about patient safety and a lack of data regarding the safety records of office-based procedures. Mandatory reporting of adverse incidents would further ensure the safety of such procedures. However, adequate safety mechanisms need to be incorporated so that physician-patient confidentiality is not violated. The AAD continues to support regulation that ensures the best care for patients but does not hamper the ability to provide it.
American Academy of Dermatology, Schaumburg, Illinois NOTE
The authors respond: The AAD’s efforts to develop appropriate care guidelines for liposuction are commendable. However, Fred Castrow’s letter highlights the importance not only of guidelines, but of more and better data on the incidence of adverse events in the outpatient setting. The research letter that he cites is, in fact, one of the few published reports on data collected by the state of Florida in the first twelve months after it mandated reporting in February 2000. However, the fifty-five reports, including six deaths, analyzed by that letter writer are insufficient to generate definitive conclusions about safety in the office setting, especially since they are contradicted by peer-reviewed data published elsewhere.1 Moreover, we are confused by Castrow’s invocation of patient-physician confidentiality as a potential barrier to reporting office-based adverse events. Until a wider spectrum of data on error in the outpatient setting becomes available, we reiterate our belief that patient safety is dependent upon both how and where procedures are performed.
Princeton University, Princeton, New Jersey NOTE
| ||||||||||||||||||||
