The Ever-Present Costs of Cosmetic Surgery Tourism: A 5-Year Observational Study

Unanticipated Economic Burden of Cosmetic Surgery Tourism: A Single Academic Center's Experience

INTRODUCTION

Cosmetic surgery tourism is a burgeoning field, attracting patients with the possibility of procedures at reduced costs. Patients are often unaware of the potential cost of managing complications, with the cost often passed on to the local healthcare systems. We report our experience at a single academic center which serves as a safety net hospital managing cosmetic surgery tourism patients.

METHODS

Cosmetic surgery tourism patient demographics and outcomes were reviewed between March 2020 and September 2021 at our institution.

RESULTS

We identified twenty-four female patients, averaging 35.6 years of age. All patients underwent body contouring procedures, most commonly abdominoplasty (17/24), frequently combined with liposuction or breast augmentation. On average, patients presented 32 days after their operation. All patients utilized emergency department resources, and 20/24 patients were admitted, averaging 5.5 days per admission. Fifteen required an additional procedure, including four who returned to the operating room. Twelve patients traveled internationally for surgery, ten to Mexico and two to the Dominican Republic. Domestically, Miami, Florida, was the most popular destination (8/12).

CONCLUSION

After developing a complication, patients frequently utilized emergency department resources and often were treated by non-surgeons before arriving at our institution. Surgical tourism continues to place the onus of finding appropriate postoperative care on patients, with their surgeon some hundreds of miles away. Additionally, the unanticipated cost of complications often exceeds the cost of their index procedure.

LEVEL OF EVIDENCE IV

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Domestic and International Cosmetic Tourism Complications Presenting to a US Tertiary Hospital

BACKGROUND

Cosmetic surgery tourism has become a significant global industry. Often patients who develop postoperative complications present for care in their US home state.

OBJECTIVES

In this study we evaluated patients who either traveled abroad or to other states within the United States for cosmetic surgeries and later came with complications for treatment at the authors' center. We sought to compare rates of complications between patients who underwent cosmetic surgery internationally and domestically.

METHODS

In this retrospective cross-sectional study we reviewed patients who presented from June 2014 to June 2022 with concerns related to cosmetic surgeries performed in another state or abroad. Binary logistic regressions were performed to assess differences in outcomes between domestic and international cases, including complications, interventions, and admissions.

RESULTS

One-hundred twenty-three patients (97.6% female, mean age 34.0 ± 8.7 years, range 16-62 years) sought 159 emergency department consultations. The most common procedures included abdominoplasty (n = 72) and liposuction (n = 56). Complications included wound dehiscence (n = 39), infection (n = 38), and seroma (n = 34). Over one-half of patients required intervention. Twenty-nine patients (23.6%) required hospital admission. On multivariate regression analyses, incidence of seroma (P = .025) and oral (P = .036) and intravenous antibiotic prescriptions (P = .045) was significantly greater among the international cohort than the domestic, and all other complication variables were nonsignificant. There were no other significant differences in operative interventions or hospital admissions between international and domestic cohorts.

CONCLUSIONS

Compared to domestic tourism cases, international tourism cases were associated with significantly higher rates of seroma formation and antibiotic use. There were no significant differences otherwise in overall complications, including infections, operative interventions, or hospital admissions.

LEVEL OF EVIDENCE: 3

Aesthetic Surgery Tourism: An Opportunity or a Danger?

BACKGROUND

Medical and surgical tourism is a rapidly growing phenomenon in post-pandemic Europe. The exodus of patients abroad to perform surgery, especially cosmetic treatments, is spreading recently in industrialized countries. In the social media era, the ease of access to advertising about surgical procedures and their costs favors traveling. However, the information given is not always punctual, and there is often a lack of patient awareness about the risks related to the procedures.

METHODS

The objective of the manuscript is to investigate, through clinical examples, the path that a patient operated on in a non-European country must face once he returns home. From the availability and translation of clinical documentation to the problems encountered in revision surgeries.

RESULTS

Thirteen cases of surgical tourism, patients who presented to our department with surgical complications, are investigated. Adverse events occurring during medical treatment abroad raised medico-legal and appropriateness issues, as well as concerns regarding the follow-up of patients.

CONCLUSIONS

The current literature confirmed the high complication rate: It affects individual patients and the native country's healthcare systems. Therefore, patients must learn more about the dangers of traveling abroad for surgery. Education initiatives in the patient's home country might help achieve this.

LEVEL OF EVIDENCE IV

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

The cost of cosmetic surgery tourism complications to the NHS: A retrospective analysis

INTRODUCTION

Medical tourism refers to the process of patients travelling outside of their native country to undergo elective surgical procedures and is a rapidly expanding healthcare phenomenon [1-3]. Whilst a multitude of established Private Healthcare Providers (PHPs) offer cosmetic surgical procedures within the United Kingdom (UK), a growing number of patients are opting to travel outside of the UK to undergo cosmetic surgery.

AIM

To assess the number of patients presenting to the Canniesburn Plastic Surgery Unit, with cosmetic surgery tourism complications, from outside of the UK, and the associated costs to NHS Scotland over a five-year period.

METHODS

A retrospective case review of a prospectively maintained trauma database, which records all acute referrals, was undertaken analysing patients referred from January 1st 2019 to December 31st 2023 inclusive.

RESULTS

81 patients presented over five years with complications of cosmetic surgery tourism. The most common presenting complaints were wound dehiscence (49.4%) or wound infection (24.7%). The total cost to NHS Scotland was £755,559.68 with an average of £9327.90 per patient.

CONCLUSION

This is the largest single centre cohort of cosmetic surgery tourism complications reported within the NHS to date; with rates on the rise, demand grows for increased patient information regarding healthcare tourism risks, a national consensus on the extent of NHS management and urgent international collaboration with policymakers is required to address this issue across borders.

Unintended Souvenirs: Case Report of a Retained Foreign Body During Cosmetic Surgery Tourism

Medical tourism has grown exponentially, spurred by incentives such as cost reductions, minimal wait times, and the allure of recuperative vacations. However, this trend carries substantial risks, as illustrated by the case of a 52-year-old female patient who underwent an abdominoplasty as part of a medical tourism package in Miami, FL, which resulted in a retained foreign body. The case highlights the broader issues of continuity of care, patient safety, and the legal and ethical ramifications faced by patients opting for medical tourism surgical procedures domestically and abroad. It also emphasizes the need for updated standards from professional societies and international cooperation to safeguard patient well-being in the expanding medical tourism sector. Lastly, it underscores the need for physicians and surgeons who manage these complications at home to recognize that prompt management and intervention are critical to avoid the escalation of complications and the increased risk of morbidity and mortality.

Level of Evidence 5 Therapeutic

Managing complications following cosmetic surgery after the COVID pandemic: A study of a year at an NHS plastic surgery unit

BACKGROUND

The study was an analysis of patients managed by plastic surgery services at Heatherwood and Wexham Park hospitals during the calendar year 2022 for complications following cosmetic surgeries performed both internationally and within the United Kingdom.

METHODS

Patients were identified via local databases and encounters and management confirmed with retrospective studies of patient electronic medical records.

RESULTS

23 patients were managed during the year 2022 for complications post cosmetic surgery. 91% (n = 21) of complications were related to breast cosmetic surgery and/or abdominoplasties. 78% (n = 18) of patients presented within the first two months following their procedure. The most common complications identified were wound dehiscence 43% (n = 10), post-operative infection 39% (n = 9) and seromas 30% (n = 7). The most common country selected for surgery by patients was Turkey with 48% (n = 11) of managed patients. 52% (n = 12) of cases were managed conservatively and 48% (n = 11) of cases required invasive procedures including surgery. 87% (n = 20) of patients were discharged with completed treatment.

CONCLUSION

Cosmetic surgery and tourism are an in-demand phenomenon and appear here to stay. The stringent regulatory and legal processes in place in the UK may not be applicable abroad to the detriment of patient care. Greater effort is needed to increase public awareness to the risks involved in seeking international options and how to self-screen suitable clinics. Ongoing current national auditing may need to be expanded to understand the true impact on NHS units in dealing with the aftermath of these surgical expeditions.

Plastic Surgery Tourism: Complications, Costs, and Unnecessary Spending?

Background

The liability of plastic surgery tourism in patient health and postoperative resource allocation is significant. Procedures completed within the context of medical tourism often lack rigorous quality assurance and provide limited preoperative evaluation or postoperative care. Not only does this jeopardize the patient's well-being, but it also increases the financial burden and redirects invaluable resources domestically through often unnecessary diagnostic tests and hospitalizations.

Objectives

This manuscript will examine the complications and associated costs following plastic surgery tourism and highlight unnecessary expenses for patients with outpatient complications.

Methods

A retrospective review was conducted of all patients 18 years or older who underwent destination surgery and were seen within 1 year postoperatively in consultation with plastic surgery at our health system between January 11, 2015 and January 7, 2022. Patient admissions were reviewed and deemed necessary or unnecessary after review by 2 physicians.

Results

The inclusion criteria were met by 41 patients, of whom hospitalization was deemed necessary in 28 patients vs unnecessary in 13 patients. The most common procedures included abdominoplasty, liposuction, breast augmentation, and "Brazilian butt lift." The most common complications were seroma and infection. Patients deemed to have a necessary admission often required at least 1 operation, were more likely to need intravenous antibiotics, were less likely to have the diagnosis of "pain," necessitated a longer hospitalization, and incurred a higher cost. The total financial burden was $523,272 for all 41 patients.

Conclusions

Plastic surgery tourism poses substantial health risks, the morbidities are expensive, and it strains hospital resources.

Level of Evidence 5

Medicolegal Cases in Bariatric Surgery in the United Kingdom

PURPOSE OF REVIEW

To evaluate the current state of bariatric medicolegal activity and explore the reasons of litigation in bariatric surgery. The underlying legal principles in bariatric medicolegal cases and most frequent pitfalls will also be discussed.

RECENT FINDINGS

There is a growing number of litigations in bariatric surgery, particularly relating to complications and long waiting lists for bariatric surgery within the public-funded health systems. The main issues are related to consent, lack of follow-up, delayed identification of complications and lack of appropriate emergency management of complications, involving bariatric surgeons, clinicians, general practitioners and multidisciplinary team members. Appropriate multidisciplinary involvement pre- and postoperatively and robust follow-up protocols can help to mitigate the risks. Bariatric surgery requires a unique paradigm with a multidisciplinary approach both pre- and postoperatively to improve the long-term functional outcomes of patients. There is a rising incidence of medicolegal claims following bariatric surgery. The underlying reasons for this are multifactorial including an increase in the volume of surgery, high patient expectations, the incidence of long-term postoperative complications and the requirement of long-term follow-up.

Infective complications of cosmetic tourism: A systematic literature review

BACKGROUND

Cosmetic tourism has increased dramatically over the years. We performed a systematic review of the literature to find reports of infective complications following cosmetic surgery, focusing on epidemiology, clinical, and surgical management. In addition, we identified cosmetic tourism trends in terms of mobilization from the country of origin and travel destinations.

METHODS

A search on PubMed, Embase, and Web of Science was performed between March and August 2022. The search was not restricted based on study date. Only English manuscripts were assessed. Reviews, short communications, letters, and correspondences were excluded after reviewing their references for potentially relevant studies. Articles related to non-cosmetic surgeries were also excluded from the study.

RESULTS

We identified 152 articles, of which 31 were duplicates and 47 were excluded based on title/abstract assessment. Three non-English manuscripts, 13 reviews, 12 letters to the editor, and 10 articles that did not feature clinical cases were also rejected. Thirty-six articles were included for analysis. We found 370 patients with infective complications following cosmetic surgery. The severity of complications was stratified according to the Clavien-Dindo classification. Most reports were from the United States (56.5%), followed by Switzerland and the United Kingdom. Travel destinations included the Dominican Republic (34.3%), Turkey, and Colombia.

CONCLUSION

Infective complications commonly occurred after abdominoplasties in patients who underwent cosmetic surgeries in Latin America or Asia. Most infective complications required management with surgical procedures that involved the administration of local, regional, or general anesthesia. Gluteal augmentations were the fourth most common cosmetic procedures; however, they were associated with the highest number of severe cases, which required intensive care treatment.

Comparing the safety profiles of implants and autologous fat grafting in gluteal augmentation: A systematic review

Gluteal augmentation has become a popular esthetic procedure since its inception. The main methods are augmentation using implants or autologous fat grafting, which is the harvesting and grafting of patients' own fat tissue. The last review comparing the safety of these methods was written 7 years ago, which warrants the writing of a new one. PubMed, Cochrane, and Medline were searched for studies focusing on the methods of gluteal augmentation listed previously. Five search terms were used and 15 studies fulfilled the criteria. The data were cataloged according to the method described and outcomes compared. Seven articles focused on gluteal implants and another seven assessed autologous fat grafting, whereas one detailed both. The most common complications in 524 implant procedures were wound dehiscence (9.16%), excessive implant palpability (5.92%), and seroma (3.82%), with an overall complication rate of 25%. The most common complications in 1788 gluteal fat augmentation procedures were seroma (6.9%), infection (3.0%), and transient sciatic paresthesia (1.0%), with an overall complication rate of 13%. Several articles listed satisfaction figures, but these were not assessed because this article was not powered to assess this outcome. Overall, gluteal augmentation using autologous fat grafting leads to fewer postoperative complications than implants and allows greater contouring of the buttocks and the surrounding areas. However, it can also be a far more dangerous procedure if certain recommendations are not followed.

An Objective Analysis of Quality and Readability of Online Information for Patients seeking Cosmetic Surgery Abroad

Increasing numbers of patients are travelling abroad to undergo cosmetic surgery. This is associated with complications that often become the responsibility of clinicians in the patients' home countries. While seemingly lower cost treatments abroad may seem attractive, prospective patients should be made aware of the hidden costs of postoperative complications and their associated morbidity. Many internet sources of information regarding these procedures originate from commercial providers in the form of advertisements, which may not highlight the potential complications to prospective patients. Our study aims to perform an objective analysis of the quality and readability of online information for patients seeking cosmetic surgery abroad using tools such as JAMA and DISCERN scores. We found that the majority of online information available to prospective and current patients regarding travelling abroad for cosmetic surgery is unregulated, distributed by commercial providers and often lacking relevant and reliable information. Due to the strong influence that the internet can have on patients' decision making, it is important that reputable, informative online material is circulated regarding these procedures. Further work needs to be done by professional bodies and medical professionals in the plastic surgery community to improve patient education in this area.

The changing face of cosmetic surgery regulation: a review of controversies and potential reforms

Cosmetic surgery is becoming increasingly popular in Australia with the industry estimated to be worth over 1 billion dollars annually. Regulators both in Australia and internationally have been criticized for not keeping up with the rapidly changing field and keeping patients sufficiently safe in an environment that is problematically entrepreneurial. In this article, we explore the current regulation of and controversies surrounding cosmetic surgery in Australia, including the use of the title 'cosmetic surgeon', consent processes and the phenomenon of medical tourism. Lastly, we review the potential future reforms in Australia and how other countries have regulated the industry to keep patients safe.

Cosmetic tourism during the COVID-19 pandemic: Dealing with the aftermath

BACKGROUND

Despite government restrictions during the coronavirus (COVID-19) pandemic, cosmetic tourism continued to occur. The authors present the impact of cosmetic tourism on their plastic surgery unit.

METHODS

Retrospective case note review of two cohorts was performed: COVID-19 (March 2020-April 2021) and a pre COVID-19 comparator (January 2019-February 2020). Patients presenting with complications from cosmetic tourism were included and their hospital notes were reviewed.

RESULTS

Seven patients were identified in the COVID-19 cohort compared with four patients in the comparator. In the COVID-19 patient group, six underwent their procedure overseas. The final patient was operated on in the UK by a visiting surgeon. Cases consisted of two abdominoplasties, two breast augmentations, two gluteal augmentations, and the final patient had a hernia repair. The most common presenting complaint in the COVID-19 cohort was a post-operative wound infection (n = 5), of which two had deeper associated collections, with two further wound dehiscences. In the pre-pandemic group, four patients underwent their procedure overseas. Cases consisted of an abdominoplasty, a blepharoplasty, a breast augmentation and a gluteal augmentation. Two patients presented with a wound infection, and two with simple wound dehiscence.

CONCLUSION

Cosmetic surgery tourism is a growing industry with an increasing number of patients presenting with complications to NHS services. These patients are a potentially vulnerable group who exhibit risk-taking behaviours, such as going abroad amidst a pandemic and acceptance of not having appropriate follow up care.