Three Decades of Outpatient Plastic Surgery Safety: A Review of 42,720 Consecutive Cases.

Background: Outpatient plastic surgery offers cost-effective solutions and enhanced privacy but demands careful patient assessment for suitability and vigilant anticipation of adverse events. This study provides recommendations to enhance patient safety in outpatient settings by analyzing over 40,000 consecutive cases spanning across three decades.

Methods: We retrospectively reviewed all consecutive cases completed by board-certified plastic surgeons at an accredited outpatient surgical center between 1995-2023. Patient demographics, operative details, and postoperative complications were recorded to determine risk factors for complications and inpatient admissions. A subgroup-analysis for procedures of the face, breast and body was also performed.

Results: 42,720 consecutive cases were performed with an overall complication rate of 0.74 percent (n=318). Patients who experienced a VTE or an inpatient transfer, had a higher BMI (p<0.05), longer operative duration (p<0.05) and were more likely to have undergone combined procedures (p<0.05) compared to those who did not. Undergoing a combined procedure was the strongest predictive factor for VTE and inpatient admissions (OR=12.65, OR=3.73; p<0.05), followed by longer operative time (OR=1.45, OR=1.32; p<0.05).

Conclusion: To our knowledge, this is the largest long-term private practice plastic surgery study in accredited outpatient settings spanning almost 30 years, further confirming that outpatient plastic surgery can be done in a consistent and safe manner with proper preoperative evaluation and patient optimization. Postoperative monitoring should be considered for high-risk patients, particularly those with a BMI exceeding 26 kg/m², operative times surpassing 3 hours, lipoaspirate volumes greater than 3 liters, and patients undergoing combined procedures - particularly in cases involving abdominoplasty.