an unspoken concern
While most plastic surgeons will describe the risks of performing an elective surgical procedure, very few tend to speak directly about issues related to safety and post-operative complications. Often a surgeon will make a general statement about the risks of surgery, such as “All surgery carries risks including bleeding, infection, shortness of breath, swelling, blood clots, and other illnesses in a small percentage of patients,” and then go straight on. to talk about the benefits of the procedure. Patients should educate themselves about the real risks associated with cosmetic surgical procedures, especially the risk of stroke or cerebrovascular accident (CVA). As a doctor, I understand that there is no value in scaring our patients for no reason. However, I remain a firm believer that patients should never decide too quickly on an elective surgical procedure without fully realizing the potential for devastating complications.
Both patients and physicians should recognize that most patients who receive some form of cosmetic care are generally considered to be healthy individuals. Thus, neither the patient nor the doctor are necessarily prepared for the appearance of a complication. This fact alone can make a complication much more serious than if the same complication arose during a medically necessary procedure. For example, even during routine knee surgery, doctors don’t see their patients as completely healthy and are more cautious about developing blood clots or other risk factors for stroke.
While the approximate one to two percent of cosmetic surgery patients who will experience a stroke appears to be a very limited number of patients, the effects of these strokes can be devastating.
Who is at risk?
Few patients really consider themselves at risk for a possible stroke because they associate the condition as an event that occurs in people over 55 years of age. Although in some cases age has a factor, it is far from being the determining factor of a stroke. In fact, a healthy 65-year-old woman may be less likely to have a stroke than a 35-year-old woman undergoing invasive cosmetic surgery. Patients need to understand the causes of stroke in a postoperative setting to more realistically assess their level of risk. As a physician, however, I can attest to the fact that sometimes there is simply no way to determine why a stroke occurred in one person and not another with the same health history, risk factors, and surgical procedure.
Most postoperative strokes occur when a blood clot breaks loose, which usually occurs in the lower part of the body. This blood clot then travels through the body and can lodge in the brain or, more commonly, in the lungs. This action of a blood clot traveling through the body after surgery is commonly known as an embolism and usually arises from a larger blood clot that usually forms in the lower part of the body known as deep vein thrombosis or “DVT”. “. DVT is a primary concern for surgeons and can be considered a precursor to stroke.
Understand the potential danger
Blood clots usually get trapped in the lung or brain when they break free from other parts of the body. When the blood clot gets trapped in a blood vessel in the brain, a stroke or cerebrovascular accident occurs. When it becomes trapped in a blood vessel in the lung, it is known as a pulmonary embolism, or PE. Either condition is life-threatening and can have serious consequences.
While blood clots and strokes are a significant risk for all patients undergoing any type of invasive surgery, plastic surgeons encounter a unique scenario that often makes it a little more difficult for our patients to receive treatment and help in a short period of time. Incidents of blood clots and strokes can occur anywhere from several hours after the operation to approximately ten days after surgery. Therefore, these incidents rarely occur within a medical setting and usually occur in the home. Patients who remain in the hospital or medical facility after a medically necessary procedure are more likely to have these incidents in the hospital.
Patients undergoing a cosmetic procedure, or any type of surgery, should become familiar with the general symptoms of post-surgical pulmonary embolism or stroke. Symptoms including shortness of breath, chest pain, disorientation, and sometimes even a sense of altered mental status, are likely related to a pulmonary embolism or stroke. Both patients and physicians should also understand the basic risk factors for these complications prior to a surgical procedure. While studies are still underway that will help determine a patient’s level of risk in the future, there are some fairly basic factors that point to a potential candidate.
Risk factors for patients
Women are more likely to experience these types of complications than men, as are smokers. There are numerous medications that place patients at an increased risk of postoperative blood clots, including but not limited to hormone replacements and birth control pills. Weight plays a significant factor as does the level of activity in which the patient usually participates. Patients who generally lead a sedentary lifestyle are at higher risk. Obese patients are at even higher risk. Increasing age and a prior history of deep vein thrombosis are more obvious risk factors. Patients who have a current cancer diagnosis are at particularly high risk.
Reduction of risk factors for a safer surgery
Whenever a patient is booked for surgery in my practice, I always insist that they have a medical clearance from an internist to help determine their overall risk level for elective surgery and the potential for medical complications, including risk of blood clotting. abnormal. I also take into consideration the type of surgery I am performing on the patient. In general, surgical procedures that have a longer operative time and involve body contouring carry a higher risk than those that are minimally invasive and performed on the head and neck. The internist will review a list of current and recent medications, as I do myself, and verify that the patient is physically able to tolerate the desired procedure. There are no guarantees yet, but knowing a patient’s medical history, her obvious risk factors, and having a second set of eyes to review the same information presented to me ensures that I am taking every possible precaution.
I also use what are known as pneumatic compression boots for all patients undergoing any surgical procedure and urge other doctors to do the same. These boots can keep your lower extremity muscles moving in a similar way to walking, which can help prevent blood clots from forming. I insist that my patients lead an active lifestyle, to help prevent DVT from forming and to directly assist with pre- and post-operative care. Proper positioning in the operating room also allows additional prevention of blood clot formation.
Physicians and patients must understand that the potential for serious complications related to cosmetic surgery can be devastating. Knowledge is power and education can help reduce the number of blood clots and complications as rare but devastating as strokes that occur after surgery. With current research and education practices, we should be able to reduce the number of postoperative strokes and blood clots for years to come.
