Explore Plastic Surgery - Dr. Barry Eppley

In the February 26, 2010 issue of the New York Times, Andrew Pollack wrote about an ever-increasing problem…hospital-acquired infection and antibiotic-resistant bacteria. While a hospital is the place to recover from severe illness or undergo major surgery, there is a flip side to concentration of illnesses… being a depot and breeding ground for bacteria of all types.

Hospitals unintentionally contribute to the development of this bacterial problem through the necessary use of a lot of antibiotics. Third and fourth generation antibiotics create the opportunity for bacteria to not only develop resistance but to create whole new strains never seen before. This is particularly true when it comes gram-negative bacteria. Most everyone has heard of MRSA (methicillin-resistant Staphylococcus aureus, a skin-based bacteria) and the problems it poses have been well chronicled.

But gram-negative bacteria, such as Acinetobacter and Klebsiella, will soon become household names like MRSA because of their increasing frequency. They are particularly problematic not only because of their drug-resistance but because there are few drugs available that have been developed to treat them. Clearly, interaction with places where such bacteria have the opportunity to proliferate are best avoided if possible.

It is exactly for this reason that I perform elective cosmetic surgery, when possible, in a non-hospital setting. In a private surgery center, the patient population is not coming in sick or knowingly harboring infectious problems. Elective plastic surgery procedures do not involve body cavities or entering body sites where gram-negative bacteria reside in any significant numbers. The  mouth would be the one exception but the potential bacterial contaminant there is streptococcus, a gram positive bacteria, that remains responsive to many antibiotics.

One of the very unique realities of operating in a hospital is what type of patient and their medical problems were done in the operating room before your case. It could have been a bowel resection, a hip replacement, or the drainage of an abscess. While operating rooms are cleaned during case turnover, they are not ‘sterilized’ as this is not only not possible but impractical. They are cleaned as much as humanly possible. A plastic surgeon has little, if any, control as to what cases were done in your room hours or days before in most cases.   

In my elective plastic surgery experience in a surgery center, the infection rate has been so low that I can only recall a few over many years. (both were from implants placed through the mouth) I do not know of any specific studies that have compared infection rates from elective surgery in surgery centers vs hospitals. But it is reasonable to assume that there is a significant difference given the makeup of the patient populations.

When possible, my preference is to do elective plastic surgery in environments where the infection risk may be lower. In insured patients, the cost to the patient is often higher when done outside of a hospital and that factor directs the surgery to a hospital location. In non-insured or cash paying patients, however, one of the potential benefits to a private surgery center is the potential for less exposure to problematic bacteria.   

Dr. Barry Eppley

http://www.eppleyplasticsurgery.com

http://www.ologyspa.com

Indianapolis

Demand for cosmetic plastic surgery continues to increase. Last year, Americans spent over $11 billion on 11 million cosmetic procedures, a 50% increase over the number performed in 2000. While TV shows like Extreme Makeover or Dr. 90210 always show great results, cosmetic plastic surgery is not without risk. After all, surgery is surgery.

The most common dangers or ‘complications’ are numbness, seroma, and poor healing (necrosis). Temporary numbness or loss of feeling at the site of the incisions is common in facelifts and tummy tucks, although it is rarely permanent. Seroma is a collection of watery body fluids that occurs most often in tummy tucks and usually a preventative measure, such as inserting a drain during surgery, is often done. Some tissue death from surgical handling, known as necrosis, may occur when long incisions are made on the body and the skin is widely undermined. This may result in incisions coming apart as the skin struggles to heal the cut edges. Your risks increase significantly for that problem if you are a smoker. That’s because smoking affects blood supply to the tissue, furthering the injury due to the surgery. While everyone worries about infection, these are fairly rare in plastic surgery patients, since most are healthy to begin with.

The single best way to lessen the likelihood that these problems may occur is to have a competent surgeon doing your procedure in the right type of setting or location. This can be done by:

- Make sure your surgeon is board-certified in plastic surgery. This is the only
organization that certifies competency in all areas of plastic surgery. You can
check our your surgeon’s standing with the American Board of Plastic Surgery,
based in Philadelphia.
- Make certain your surgeon has the necessary experience to perform the procedures
you want. This can be done by asking for their before and after surgery examples,
given a name(s) of patients that have had the procedure in the past 30 days so you
can speak to one of them, and ask questions until you are satisfied. If you meet
resistance or delays on any of these requests, find another surgeon!
- Make certain that your surgery is going to be performed in a hospital or surgery
center that is a fully accredited facility. For hospitals, this is the JCAH (Joint
Commission on Accreditation for Health Care Organizations). For surgery centers, this is the AAASC (American Association of Ambulatory Surgery Centers).

These three simple and easily verifiable qualifications will help ensure that you have the best chance for a good plastic surgery result.

Dr Barry Eppley
www.eppleyplasticsurgery.com
www.ologyspa.com
Clarian North Medical Center, Carmel, Indiana
Clarian West Medical Center, Avon, Indiana
Indianapolis