AAAHC Institute for Quality Improvement Provides Clinical Performance Measurement for Outpatient Liposuction Procedures

WILMETTE, Ill. -- A new "Liposuction With Sedation, Regional, and/or General Anesthesia" study fielded by the AAAHC Institute for Quality Improvement gives insights into issues relating to outpatient liposuction, the most commonly performed aesthetic procedure. One of the key findings of the study was that the clinical complication rate was 3 percent, representing 11 cases out of 349 studied. The Performance Measurement Initiative (PMI) study, designed to provide opportunities to initiate clinical performance measurement on key processes and outcomes for this procedure, was conducted with 30 outpatient organizations that volunteered to participate.

Part of the rationale for studying liposuction is that there has been considerable concern about the safety of office-based surgery especially liposuction. As with any surgical intervention, there are risks and reported complications associated with liposuction. For liposuction, these range from minor aesthetic skin problems, to wound healing, necrotizing fasciitis, to hypothermia and pulmonary embolism, fluid overload/hypotension/pulmonary edema, and cardiotoxicity, to name a few. In addition, debates have ensued about what constitutes safe volumes of fat removal (and the association of volume of fat removed with blood loss) as well as the appropriate and safe level of lidocaine administration. Media coverage and the peer-reviewed literature show growing concern about the safety of liposuction, especially in the office setting

The intent of the AAAHC Institute's latest liposuction report is to offer, via performance measurement information, alternatives in practice to organizations, physicians, and nurses, allowing these providers to give the safest care and best value to their patients. Findings of interest include the following:

-- In a ranking of the frequency of the body areas in which liposuction was used, the most common locations were the lower abdomen, the upper abdomen, flanks and hips.

-- In evaluating supranatant fat and fluid extraction:

-- Supranatant fat and fluid extracted ranged from 10 ml to 13,700 ml.

-- Median volume was 2,075 ml

-- Average volume was approximately 2,620 ml.

-- In 12 percent of the cases (40) more than 5,000 ml of fluid was extracted.

The American Society of Plastic Surgeons guideline recommends that the procedure be performed inpatient if the amount of aspirate anticipated is greater than 5,000 ml, whereas the American Society for Dermatologic Surgery and the American Academy of Dermatology Guidelines of Care recommend that no liposuction be performed if the amount of aspirate is greater than 5,000 ml, regardless of location, in- or outpatient.

With regard to extraction of fat (without supranatant fluid):

--Fat extraction ranged from 25 ml to 11,600 ml

--Median volume was 1575 ml

-- Average volume was approximately 2115 ml.

The American Academy of Dermatology clinical practice guideline recommends that no more than 4,500 ml of fat should be extracted during a single operative session. There were 18 cases with more than 4,500 ml of fat extracted.

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For those cases where this was listed, there was a range of lidocaine doses reported:

-- From 0 to 66 mg/kg

-- A median of 26 mg/kg

-- An average of 25 mg/kg.

The American Academy of Dermatology (AAD) clinical practice guideline has cited 55 mg/kg as a safe limit. A more conservative guideline recommendation, from the American Society of Plastic Surgeons (ASPS), is a maximum of 35 mg/kg total lidocaine dose.

Procedure time (cannula in to cannula out) ranged from 51 to 262 minutes (approximately 1 to 4 hours), with a median of 95 minutes, and average of 110 minutes.

Of the 98 percent of patients who responded to a one-week post-operative survey, 61 percent recalled their procedures and 89% had an intra-operative comfort rating of "1" (66 percent) or "2" (23 percent) on a scale of 1 to 5, with "1" equal to no discomfort during their procedures.

Of the 66 percent of patients who responded to a 6 month post-operative survey, 94 percent were positive about their decision to have liposuction (rating of 4 or 5 on a scale of 1 to 5) and 89 percent had high levels (4 or 5 on a scale of 1 to 5) of overall satisfaction with the procedure.

The AAAHC Institute is among the few organizations to provide those in the ambulatory care arena with opportunities for benchmarking on a national level.

The AAAHC established the AAAHC Institute in 1999 to provide ambulatory health care organizations opportunities to participate in clinical performance measurement studies and educational programs. To date, the AAAHC Institute has conducted and published 15 clinical performance measurement studies and has convened a national forum on quality improvement in ambulatory healthcare annually. Involvement in clinical performance measurement is a signal to patients, government agencies, professional liability insurers, and third-party payors, that an ambulatory health organization is concerned about continually improving the care it provides to its patients.

Source: AAAHC