An analysis of the cost and impact of cosmetic tourism and its associated complications: A multi institutional study

On Medical Tourism Overseas: Ethical Analysis of the Duties of NHS Doctors in Managing the Negative Health Consequences of Accessing Medical Treatments Abroad

INTRODUCTION

An increasing number of UK residents are travelling overseas to access medical treatments, the negative health consequences of which are largely managed by NHS doctors.

METHODS

This paper performs an ethical analysis, using the ethical framework of principlism, of the duties of NHS doctors in managing these negative health consequences of medical tourism overseas.

FINDINGS

While the doctor's duty to respect patient autonomy contains a negative duty to not interfere with their choice to access medical treatment overseas, it also contains a positive duty to ensure this choice is informed. This requires those considering medical tourism overseas to be counselled on the risks. This should take place directly by counselling, and indirectly through public health messaging. Beneficence requires the doctor to promote the patient's health, therefore obligating them to treat complications of medical tourism overseas, to intervene if poor cosmetic outcomes negatively impact the patient's mental health, and to refer the patient if the necessary aftercare is insufficiently or entirely unavailable on the NHS. Beneficence also requires doctors to remove harm, meaning they must counsel patients about the risks of medical tourism overseas to minimise the risk of negative health consequences. Justice requires NHS doctors to care for patients according to their clinical needs regardless of how that need has arisen, including the negative health consequences of medical tourism abroad, and requires NHS doctors to minimise these negative health consequences to minimise the scarce resources allocated to addressing them. The duty of non-maleficence is not relevant in this context.

CONCLUSION

Amongst other requirements, this paper finds that NHS doctors must counsel those considering medical tourism overseas on the risks of doing so, and existing efforts to do so should be increased to reflect the increasing prevalence of medical tourism overseas by UK residents and the associated negative health consequences.

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

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Stature seekers: Cosmetic limb lengthening in medical tourism a case report

This case report details orthopaedic cosmetic surgery tourism, an emerging trend where individuals seek orthopaedic cosmetic procedures abroad. While this practice is increasingly common, it lacks regulation, potentially endangering patients. Factors driving this trend include rising healthcare costs and lengthy waitlists in public healthcare systems. Patients often pursue surgery abroad to save costs, or access specialised procedures not available domestically. However, complications can arise, necessitating costly management back home. Surgeons may face challenges due to unfamiliarity with overseas care, while patients encounter language barriers and variations in medical standards. This case report highlights a 28-year-old male who underwent bilateral limb lengthening surgery in Turkey, experiencing serious complications. While existing data on cosmetic tourism mainly focuses on plastic and bariatric surgeries, documentation specific to orthopaedic cases is limited. This report underscores the need for further research and regulation in this rapidly growing field, to ensure patient safety and optimal outcomes.

The microbial etiology and resistance patterns of cosmetic tourism-related infections in Ireland

BACKGROUND

Cosmetic tourism is an increasingly common phenomenon, both in Ireland and internationally. Complications associated with procedures performed abroad may manifest after the patient has traveled back to their home country with patients often presenting to local health services. Such complications can be infectious in nature requiring either antimicrobial therapy and/or source control in the form of wound debridement or radiologically guided interventional procedures.

METHODS

Patients who had presented to a regional plastic surgery unit between September 2021 and December 2022 with complications related to aesthetic procedures performed outside Ireland were identified in this retrospective-prospective design. Medical records were reviewed to ascertain what procedures were performed, where the procedure had taken place, the nature of complications, and microbial culture and sensitivity results.

RESULTS

Thirty patients were identified during the study timeframe, predominantly female (n = 28) with a mean age of 40.27 years (SD 10.6). Abdominoplasty was the most common procedure (n = 17), and Turkey was the most frequently cited destination (70%). Wound dehiscence accounted for the majority of complications (n = 18). Wound cultures were obtained in 80% (n = 24) of patients and a causative organism was isolated in 85% (n = 34) of cultures. Eighteen species of bacteria were identified and antimicrobial sensitivities were obtained for 16 of these. Antimicrobial resistance to commonly prescribed empiric antibiotics was noted in several isolates.

CONCLUSION

Post-operative infections related to cosmetic tourism are a growing concern in plastic surgery. The bacterial etiology is varied, and antimicrobial resistance poses significant challenges, highlighting the need for early intervention and wound cultures to guide effective management.

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.

Medical tourism and medical tourists: providing a sustainable course to integrating health treatments with tourism

Medical tourism (MT) is an expanding multidisciplinary economic activity that combines the healthcare and tourist industries, with patients increasingly travelling worldwide for medical treatments. MT provides economic benefits to destinations while raising ethical, quality, informed and risk concerns for medical tourists. Greater cross-disciplinary studies and collaboration across sectors are advocated.

Challenges with medical tourism

PURPOSE OF REVIEW

With the return of international travels to almost prepandemic levels, the number of patients who travel abroad to seek healthcare services is once again growing rapidly. Nevertheless, the expected benefits of medical tourism may be challenged by serious infectious complications. This review summarizes the evolving published evidence on infectious complications related with medical tourism of the last eighteen months.

RECENT FINDINGS

There has been an increase of reported infectious complications in patients who had received healthcare abroad. Such complications were frequently associated with serious and prolonged morbidity, repeated treatments and hospitalizations, high healthcare costs, and occasionally fatalities. A devastating outbreak of fungal meningitis occurred among US residents who underwent epidural anesthesia for cosmetic surgery in two clinics in Mexico. Overall, as of July 5, 2023 there were 31 cases with severe cerebrovascular complications and eight deaths. Infections caused by nontuberculum mycobacteria and Candida sp have been also reported the last years.

SUMMARY

Considering the expected expansion of medical tourism in the forthcoming years, public health authorities and scientific societies should raise awareness of such infections among physicians and other healthcare professionals and issue recommendations for their management. A system to report complications in patients receiving healthcare abroad is needed.

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

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.