4851 The Preoperative Checklist In Aesthetic Plastic Surgery Based on Levels of Attention

Friday, May 6, 2011
Jaime Anger, MD1, Nelson Letizio, MD1, Marcio Martines, MD2, Jose Leao Souza Jr., MD3 and Mauricio Orel, MD1, (1)Plastic Surgery, Hospital Israelita Albert Einstein, Sao Paulo, Brazil, (2)Anesthesiology, Hospital Israelita Albert Einstein, Sao Paulo, Brazil, (3)Cardiology, Hospital Israelita Albert Einstein, Sao Paulo, Brazil

Goals/Purpose: Avoidable failures are present and persistent in Medicine field and may be demoralizing and frustrating in Aesthetic Plastic Surgery. The main reason for it is that the volume and complexity of what we need to know has exceeded our individual ability to deliver its benefits correctly, safely or reliably. There is a need for new strategies for overcoming failures in Plastic Surgery. Intraoperative checklist created and published in 2009 on behalf of the World Health Organization produced a significant decrease in surgical complications. We suggest a preoperative office based checklist as simple, usable and systematic form covering the maximum of risk factors related to Cosmetic Plastic Surgery.

Methods/Technique: The checklist is intended to use as a final step during the preoperative consultation. It's composed by 29 yes/no questions, 1 question to classify the level of DVT risk and 4 blank fields to be completed included in 3 tables. Each table comprehends a different Medical area: Anesthesia, Behavior and Clinical Risk Factors. (Table 1,2,3) The yes/no answers are underlined by colors. Each color represents a level of attention: green, irrelevant; blue, low; yellow, moderate and red, high. (Table 5) In the Table 4 are listed resources based on Web or IphoneŽ or IpadŽ for fast research during the consultation. The 8 and 9 listed resources are DVT citations. The questions were created based in published reports or medical guidelines. In the Anesthesia table there is the American Society of Anesthesiologists (ASA) physical status classification system commented by the Cleveland Clinic. It is followed by a blank to be completed with the ASA classification.


Results/Complications: The checklist was used in 100 consecutive aesthetic surgery patients. Psychopharmacological medication was the most frequent item requesting resource research. The need of a second person in the next consultation was most frequent change in the routine. The question about Allergy detected the larger number of mistakes mainly about medication. The most frequent item requesting previous discussion with anesthesiologist was psychopharmacological medication interaction.

Conclusion: When we prepared this checklist the idea was to review all necessary items included in the process of decision. It was also used to magnify the attention in known problematic issues. The checklist wasn't prepared to quantify every risk factor allowing statistics to enumerate and compare complications. It helped us to control the unwanted events in our surgical group surgeries showing that the use of colors in the answers appeared to be functional. There is certainly a need for larger series of patients to measure the effectiveness of this checklist, to review the risk factors and consequently to have conditions to quantify and qualify complications.



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