Thanks to blogger Dr. Bates at Suture for a Living for tipping me off to the article about the 35-year-old woman in South Florida who recently died while getting liposuction. Lidvian Zelaya went to Strax Rejuvenation Center in Lauderhill, Fla., to have fat liposuctioned from her waist and added to her buttocks, according to her husband. Three hours later, she was rushed to an emergency medical center, where she died. An autopsy is pending.
This horror story is more common that you think. Breast augmentation and liposurgery are the most common procedures in the US, and over 1.5 million cosmetic surgical procedures are performed annually. Most of these are not done in a hospital, and Med Spas in strip malls, doctors' offices and surgi-centers have no emergency capacity to handle complications. High-profile patients who die, like Kanye West's mother or the former Miss Argentina, make the news, but most complications (infection, blood clots, bleeding, poor outcome) are never made public.
I went to one site on the Internet called "Smart Plastic Surgery" and it mentioned "pre-op steps". As a comprehensive Internist, I thought, "great, this will steer patients in my direction." Wrong. Their steps included costs of the procedures, good candidates for surgery (just about everyone), and finding the right plastic surgeon.
When I say "pre-op," I mean an appointment with your primary care physician at least 2 weeks prior to surgery, where you undergo a physical exam and all other risks of surgery are fully analyzed with your personal health conditions considered. The pre-op assessment is critical before any surgery. We are looking for heart and breathing problems, diabetes, silent heart attacks, risks of blood clots or strokes, prior anesthesia history, blood abnormalities and silent infections. Even mild systemic diseases put a patient at higher risk for complications.
I don't know if Lidvian Zelaya underwent a pre-op exam, but I am willing to bet she did not. I do not know if a pre-op exam would have uncovered whatever problem led to her death. There are many questions here that have not yet been answered.
I do know that I have adjusted medication and halted or delayed surgery in the past on patients that needed further "tuning up" before surgery. I have also insisted that their surgery be done only at accredited facilities. I believe those delays may have saved their lives.