Plastic Surgery Safety


Valerie DeBenedette, Senior Medical Editor

Valerie DeBenedette is a science writer who specializes in keeping people informed about medicine and their health. She has more than 20 years of experience writing for newspapers, magazines, and websites and has written about most areas of medicine. For many years, she was a contributing writer to Cosmetic Dermatology and to Drug Topics, the leading pharmacy trade magazine. She also was a contributing editor to The Physician and Sportsmedicine for many years. She has written about most fields of medicine, including dermatology, sportsmedicine, ophthalmology, general surgery, orthopedics, and women's health; as well as public health policy and the pharmaceutical industry. In addition, she is the author of Caffeine, a book for young people. She is a member of the National Association of Science Writers.

November 14 2008

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Once upon a time, if you had cosmetic surgery—or any kind of surgery for that matter—you checked into the hospital the day before, had the surgery, and if all went well, went home in 2 or 3 days or maybe even a week. Those days are gone.

Most cosmetic surgery is performed today in either a freestanding surgical center (also called an ambulatory surgery center), a plastic surgery center or in a surgical suite in a surgeon's office. Being outside of a hospital for surgery does not mean you are in a less safe environment, as long as you make sure the site is accredited and/or licensed.

Most states, but not all, have regulations governing surgery that takes place outside of a hospital, said Michael Kulczycki, Executive Director of the Ambulatory Health Care Accreditation Program for the Joint Commission on the Accreditation of Healthcare Organizations (JCAHO) in Oakbrook Terrace, IL. More than 40 states require that surgical facilities be licensed. Twenty-three states require or recognize accreditation by an independent organization in lieu of license requirements or other regulations, and about 25 states have regulations governing surgery done in an office-setting, he said.

The JCAHO, often just called the Joint Commission, accredits hospitals and other health care organizations and programs in the United States. Two other organizations also accredit freestanding surgical sites, including surgical suites. These are the Accreditation Association for Ambulatory Health Care, Inc. (AAAHC) or the American Association for Accreditation of Ambulatory Surgery Facilities (AAAASF). A few surgical facilities are accredited by more than one of these groups, Kulczycki said. The American Society of Plastic Surgeons (ASPS) requires all of its member surgeons to operate only in accredited or licensed facilities.

States that have regulations governing surgical facilities may also have rules calling for regular state inspection. However, such requirements have been seriously weakened by budget cutbacks, Kulczycki said. The rules may call for an annual visit by a state inspector, but he or she may not come around for several years, he noted.

No states have regulations that apply specifically to cosmetic surgery performed outside of a hospital; the regulations apply to any kind of surgery, Kulczycki said. However, regulations that determine what is to be considered a surgical procedure may apply. He gave the example that New York State law applies the rules to outpatient surgery for liposuction that removes more than 500 ml of fat, but not to those procedures that remove less. A bill in California that would have required anyone seeking cosmetic surgery to undergo a physical first was vetoed by Governor Arnold Schwarzenegger.

Studies have found that surgery in accredited facilities is very safe. One study, published in Plastic and Reconstructive Surgery in July 2008, found that plastic surgery procedures performed in accredited office-based facilities are as safe as those performed in hospitals. The authors reviewed data on more than 1.1 million procedures performed between January 2001 and June 2006. The mortality rate was very low, about 0.002%. The data was collected by the American Association for Accreditation of Ambulatory Surgery Facilities (AAAASF), which mandates biannual reporting of all complications and fatalities at surgical centers that it accredits.

Despite this excellent record of safety, consumers should always take a good look at whatever facility will be the site for their surgery and ask questions, said Kulczycki. The Joint Commission has "Speak Up" materials on its website (links to: to help educate consumers about their right to ask questions and what kinds of questions to ask, he added.

Ask what accreditations the facility has. All three accreditation organizations examine the facilities, the staff, and the emergency protocols that have been set up. A facility must have a protocol in place for getting emergency help or for transporting a patient to a hospital. It must also have protocols in place for ensuring sterility in the operating rooms.

Ask for a tour of the facility, Kulczycki said. Take a look around. Ask about hygiene policies, he suggested. "Is there a requirement that, before anyone lays hands on the patient, they wash their hands or use an alcohol-based gel?" Gel dispensers should be in or near every room, he pointed out. This is a basic hygiene requirement, and one that is easy to spot.

All facilities must be reaccredited periodically. The Joint Commission, for example, conducts unannounced surveys every 3 years after the first review, Kulczycki noted. The organization also requires that a notice be posted at its accredited facilities telling consumers who they can call with a complaint.

You can find information on whether or not a facility is accredited by contacting any of the agencies listed above. Phone numbers and information can be found on their websites at,, or Complaints about facilities accredited by the Joint Commission can also be made by calling 800-994-6610.