As published on page B2 on January 18, 2006
Lengthy plastic surgery not a risk to health, study say
TORONTO (CP) - Patients who spend a protracted period under general anesthetic for facial plastic surgery aren't at increased risk of death or injury, a new scientific paper suggests.
Lead author Dr. Neil Gordon said face work, which achieves best esthetic results when several procedures are done at one time, can be safely performed even when it requires patients to go under anesthesia for more than four hours.
His study, published yesterday in the Archives of Facial Plastic Surgery, suggests the maxim that shorter is better when it comes to general anesthetic doesn't hold for facial surgery, were blood loss is minimal and it is easier to maintain a constant body temperature by shrouding patients in full-body warming blankets.
"Case duration has been anecdotally presumed to be an indicator of . . . problems in plastic surgery. And we have not found that, and nor have my colleagues who do the same thing I do across the United States. But nobody had ever really looked at it from a scientific point of view and published anything," said Gordon, a practising plastic surgeon and a professor of plastic surgery at Yale University.
Lengthy plastic surgeries have come under harsh scrutiny in recent years after several high-profile patients died as a consequence of surgery. Olivia Goldsmith, author of The First Wives Club, died in early 2004 from complications of anesthesia administered during plastic surgery. Several months later, Micheline Charest, a mover and shaker in the animation world, died while undergoing multiple procedures in a Montreal clinic.
As a result, several U.S. states have imposed a four-hour time limit on plastic surgery duration.
Charest was reportedly having a face lift, liposuction and a breast reduction - a time-consuming combination Gordon said he would not perform.
"I wouldn't combine high-volume liposuction with face work, because their risk profiles are different," he said.
Gordon and his co-author, anesthesiologist Dr. Marc Koch of the State University of New York at Stony Brook, reviewed outcomes of 1,200 patients who underwent facial plastic surgery. Gordon was the surgeon for most, though not all, of the procedures, which occurred over a 10-year period.
The vast majority - 86 per cent - were under general anesthetic for more than four hours. The average length of time patients were under was 6.8 hours.
None of the patients died. And in fact, there were only three serious adverse events, one of which required transfer to a hospital. The analysis suggested there was no increased risk in the group who spent more than four hours under anesthesia when compared to the group that underwent shorter surgeries.
While Gordon said that is suggestive procedures of over four hours are safe, a leading Canadian plastic surgeon said the number of patients studied was too small to view the study as solid proof.
"The trouble is it's so small that he hardly has any major adverse events. It's just not a big enough study," said Dr. Alastair Carruthers, a cosmetic surgeon from Vancouver.
Gordon acknowledged that the study findings didn't reach statistical significance and that larger studies, looking at thousands of patients operated on in multiple locations would be needed to prove his hypothesis.
But he suggested the trend of his data supports the notion the risks inherent in plastic surgery differ with the types of procedures being performed.
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