Plastic Surgery Tourism: Complications, Cost, and Unnecessary Spending?

Goals/Purpose: Plastic surgery tourism can have significant consequences, including potentiating medical treatment, hospital admission, and surgical correction. Not only are these harmful to the patient, but this care increases costs, utilizes needed hospital beds, and puts patients at risk for further insult. These patients generally do not have postoperative care, thus are seen in the emergency room setting, potentially receiving extensive workup and sometimes unnecessary admission. The purpose of this study was to examine complications and associated costs from plastic surgical tourism and describe unnecessary costs for patients with outpatient complications.

Methods/Technique: A retrospective review was conducted of all patients 18 years or older who received destination surgery seen in consultation with plastic surgery at our health system between 11/1/2015 and 7/1/2022. Patients seen greater than 1 year from the original destination surgery were excluded. Patient admissions were reviewed by deemed necessary or unnecessary by two physicians. Chi-square analysis, Fischer exact test and student’s T-test were used for comparative analysis with a p-value ≤ 0.05 being considered statistically significant.

Results/Complications: Forty-one patients met inclusion criteria. Twenty-eight (68%) were deemed to have a necessary hospital admission versus 13 (32%) who were deemed to have unnecessary admission. Ninety-eight % percent of patients were females with 70% having Medicaid as their primary insurance. The most common procedures included abdominoplasty (n=31), liposuction (n=23), breast augmentation (n=11) and/or “Brazilian butt lift” (n=10). The most common complications were seroma (n=23) and infection (n=21). Over 60% of patients in both groups had no follow-up with their surgeon after they left their destination. Patients with a necessary admission often required at least 1 operation (64.3% vs. 0%, p<0.001) and were more likely to need intravenous antibiotics (42.9% vs. 0%, p=0.007). Patients deemed necessary were less likely to have the diagnosis of “pain” (3.6% vs. 38.5%, p= 0.008) and had a longer average length of stay (5.3 vs. 1.8 days, p=0.003). The average cost for a necessary admission was significantly higher ($16,911 versus $3,828, p= 0.001), with total costs of $253,418 for all 41 patients.

Conclusion: Destination plastic surgery can lead to significant consequences, including multiple trips to the operating room, days of intravenous antibiotics, and a multitude of additional procedures. Seroma and infection were the most common complications, and the majority of patients did not have follow-up with their original surgeons. Many patients required admission for inpatient care, which had higher average associated costs, however, the cost of admission for patients deemed unnecessary were still costly. Whether patients had problems that could have been resolved as an outpatient or needed inpatient care, plastic surgery tourism poses substantial risk, the morbidities are expensive, and it strains hospital resources.