In the February 26, 2010 issue of the New York Times, an article on hospital-acquired infection and antibiotic-resistant bacteria was published. 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
Indianapolis, Indiana