Don’t be vein: evaluating the risk of DVT

 

cosmetic surgery risks DVTAnother interesting topic arising out of last month’s BAAPS conference was the increased risk of developing Deep Venous Thrombosis (DVT), a potentially life-threatening condition, and the worrying lack of guidelines available.

Every surgical procedure carries risk and DVT or its more dangerous sequel, Pulmonary Embolism (PE), is one of those potential risks, particularly when the surgery is lengthy. Most cosmetic surgery procedures will extend beyond an hour, meaning the patient is more susceptible to this possible outcome.

A DVT is a blood clot that develops in a deep vein, typically in the leg. It can cause pain and swelling, although some people suffer no symptoms. However, one in ten people with DVT go onto develop a Pulmonary Embolism, which is where a part of the blood clot will break off into the bloodstream and may travel to the lungs or heart. It can cause breathlessness, chest pain and, in some people, result in fatal heart failure.

Increased risk of DVT in cosmetic surgery

Guidelines will help identify patients that have an increased risk of developing DVT after surgery; these include obesity, smoking, advanced age, use of oral contraceptives or HRT and a previous history of DVT.

In a 2014 study published in Plastic Surgery International, the authors stated the importance of identifying these risk factors in minimising DVT. A total of 1,254 patients were included in the study and the development of venous thromboembolism occurred in 1.35% of patients, which may seem relatively low incidence, but a DVT may be fatal. In those patients who developed DVT, it was more frequent in patients over the age of 40, who smoked, or were taking either HRT or oral contraceptives. Interestingly, the study compared types of cosmetic surgery – liposuction, breast augmentation, breast lift and rhinoplasty – and none of these procedures was isolated as a risk factor for this condition.

However, there is a slightly increased risk in surgery to the abdomen, buttocks and legs. The popularity of the Mummy Makeover, where various surgical manoeuvres to this part of the body are combined in one surgical procedure, meaning a longer surgical time, also demands close attention to ensure patient safety.

Prevention is key

There are a number of measures that can be taken to lower the risk of developing DVT. These include the use of compression garments during and after surgery, the use of sequential compression devices to the lower limbs during surgery and afterwards until mobilization has occurred, careful positioning of the legs during the operation and prescribing anticoagulation medication for patients at most risk.

Early ambulation is also essential; the risk of DVT is highest in the first two weeks after surgery so getting out of bed and moving around as soon as possible, balanced with the necessary rest, is extremely important. 

Cosmetic surgery is purely elective so it needs to be as safe as possible for patients, which is why guidelines on identifying patients at risk and the optimal preventative measures to follow are mandatory.

The true cost of cosmetic surgery tourism

cosmetic surgery tourismCosmetic surgery tourism is on the rise as more and more people seek the best deal possible.  But what’s the true cost, both to the patient and to the NHS? As I mentioned in last month’s blog post on the increase in revision surgery, one of the main driving forces behind this surge is men and women undergoing botched plastic surgery procedures abroad and then returning to the UK, often requiring urgent medical treatment on the NHS.

Cosmetic surgery tourism and patient safety

Financial uncertainty in the UK, partly as a result of Brexit, makes the ‘cheap deals’ offered by cosmetic surgery clinics in other countries very attractive. Yet conveniently, there is no mention of the many possible complications as a result of having cosmetic surgery abroad.

Sales-driven surgery: often patients will see a representative of the clinic in the UK and believe that gives them a degree of security. However, this representative is usually a broker or salesperson, driven by financial considerations alone.

A common reason that people are left unsatisfied or in a worse state after cosmetic surgery is that they were medically or psychologically unsuited for a particular procedure – the broker has neither the professional ability or desire to evaluate patients properly. A UK plastic surgeon should have the training and experience required to evaluate a patient properly and turn that patient away if they feel that surgery is not the best option for them at that time.

Informed consent and time to consider: in the UK, we are duty-bound to give patients enough information regarding the procedure that they can make an informed decision about whether to go ahead. No salesperson or non-medical professional can provide that. And, once the patient has committed to surgery and flown to another country, the pressure on them to go ahead often means that they proceed with misgivings.

Paying for peace of mind: the price of cosmetic surgery in the UK may seem more expensive at first glance than the deals offered by clinics abroad, but do you know what you’re paying for? A reputable plastic surgeon in the UK will typically be a member of the independent plastic surgery organisations that charge membership fees – these organisations carry out annual safety audits and are committed to ensuring patient safety.

Your UK surgeon will also be performing your surgical procedure in a private hospital and this makes up a significant part of the cost. These private hospitals and clinics are under a legal obligation to meet certain standards of quality and safety and they are inspected by the Care Quality Commission in England and similar bodies in Scotland, Wales and Northern Ireland.

Furthermore, your UK plastic surgeon will be paying for medical insurance that covers potential complications arising from surgery. Cosmetic surgery tourism patients often find that there is no recourse if something goes wrong and no provision for follow-up care or further surgery.

Aftercare and follow-up: I’m a firm believer that the recovery process after a cosmetic surgery operation can be as important as the surgery itself in terms of patient satisfaction and optimal results. Any surgery carries risk, which is why it is essential to have your surgeon and their team on hand to deal with any possible complications. Infection is a common complication, often compounded by flying too soon after surgery, and needs to be carefully monitored, which is just not possible from abroad. If you do need to return for further surgery, then those costs are usually not included.

The burden on the NHS

Presented at the BAAPS meeting, was a study of patients presenting at one NHS hospital in London, with injuries resulting from cosmetic surgery abroad. Half of the complications treated at the Royal Free Hospital, London resulted from infection, with breast augmentation patients losing their nipples or tummy tuck patients requiring massive skin grafts as a result of dead and dying tissue. The cost to the hospital, from just 21 patients, was in excess of £282,000, with an average cost of £13,500 per patient.

An increasingly cash-strapped and over-burdened NHS may decide to make patients pay for any procedures arising out of botched surgery overseas in the future, meaning that ‘cheap deal’ could come with a significant and unwelcome additional cost.