The number of body contouring procedures performed in an outpatient and office based setting has increased dramatically in the past decade. The complexity of these procedures has also shown similar trends with an increasing frequency of multiple site surgeries which combine liposuction, excisional procedures, and sometimes implantable devices. More complex surgeries lead to longer operative times and an increased potential of risks and complications to the patient. Concerns for patient safety demands our top priority. Patients who undergo these procedures are often called to navigate a maze of dressings, garments, medications, and drains while maintaining responsibility for their own treatment of pain, appropriate ambulation, and even thromboembolism prophylaxis. Although surgeons develop their own postoperative regimen including patient education, the acquisition of the skills significantly varies among patients. Since so much depends on the orchestration of postoperative care including the prevention of complications, a model of care that helps to bridge this transition to truly independent self-care could provide significant benefits.
The Medallion Model is unique in its nature and allows multiple same day procedures or longer operations to be performed in an outpatient setting while maintaining them in a hotel environment supervised by nursing care. This model offers peace of mind to both the patient and the physician by giving safe, effective care immediately post surgery and extending patient and family education to facilitate their continuation of care following leave of the facility.
Methods/Technique:
A retrospective review of 275 major body contouring patients was conducted from January 2008 to January 2012. Body contouring procedures were defined as excisional surgeries excluding breast. Criteria included major body contouring procedures from one of twelve board certified plastic surgeons that required at least one overnight stay at Medallion Guest Suites. All patients with excisional procedures were recommended to stay overnight. The nature of the surgical procedure, age, BMI, comorbidities, smoking history, etc. were evaluated to determine specific trends related to minor or major complications. The purpose of this study was to look at the current model used at UT Southwestern Outpatient Surgery Center for major body contouring surgeries to determine safety, efficacy, and complication rates of patients cared for in this environment.
Major complications included a return to the operating room within 48 hours, wound infection requiring hospitilization, unplanned hospitalization, hematoma or seroma requiring surgical intervention, deep vein thrombosis, and pulmonary embolism. Minor complications included anything else requiring unplanned physician intervention within the first 30 days.
Results/Complications:
The overall complication rate including major and minor complications was 21.09% (58 patients.) Thirteen patients had wound infections for a total of 4.73%. The most common minor wound complication was seroma. There were no deaths, deep vein thrombosis, or pulmonary embolism. One patient was hospitalized due to wound dehiscence for a major complication rate of 0.36%.
Conclusion:
Comparing results for major body contouring patients is difficult. Inclusion parameters vary widely as do author definitions of favorable results and complications. In respect to previous published studies with similar parameters, our complication rates compare very favorably. The use of the “Medallion Model” for patient care after body contouring procedures shows considerable merit and could potentially reflect a template of care that could be adopted by both private and academic surgeons. Medallion allows the physician to perform multiple outpatient excisional procedures and improves patient safety following surgery.