NEW YORK, May 12 (Reuters Health) -- Complications of liposuction, the most common cosmetic procedure in the US, can kill healthy people, and the procedure should not be viewed as trivial, investigators warn.
"Deaths due to cosmetic surgery should be a matter for serious public concern," according to their report in the May 13th issue of The New England Journal of Medicine.
Five deaths referred to the Office of Chief Medical Examiner of the City of New York between 1993 and 1998 occurred in liposuction patients. From their examination of autopsy reports, Dr. Rama B. Rao from the New York University Medical Center and Bellevue Hospital Center and colleagues report that four of the patients had liposuction performed by a plastic surgeon, and one by a general surgeon. In all five cases, an anesthesiologist was present.
Rao and colleagues report that three of the patients studied died as a result of a sudden, sharp drop in blood pressure and slowed heart rate "with no definitely defined cause."
The fourth patient died of fluid overload, and the fifth died after liposuction of the legs was followed by the formation of clots in leg veins that led to pulmonary embolism, where respiratory problems are caused by clots in the lungs.
During tumescent liposuction, a physician infuses a solution of fluid under the skin that contains lidocaine. The pain-killing drug allows deposits of fat to be removed through special instruments without causing discomfort.
The team note that the local anesthetic lidocaine, used in all five patients during liposuction, can cause low blood pressure and a slowing of the heartbeat. They also suggest that the doses of lidocaine used during tumescent liposuction may be high relative to doses of the drug used for other procedures.
Lidocaine toxicity or interactions between lidocaine and other drugs a patient is taking may also lead to dangerous complications, the researchers conclude.
"Tumescent liposuction is not a trivial procedure, because it has the potential to kill otherwise healthy persons," investigators warn. They cite complications such as drug interactions, fluid overload, clotting problems, and the volume of fat removed as factors that "should be reevaluated for this popular cosmetic procedure."
The most recent survey done by the American Academy of Cosmetic Surgery indicates that over 292,000 liposuction procedures were done in the United States in 1996. This is an increase of more than 300% from 1990. Over 90% of these were categorized as tumescent procedures.
SOURCE: The New England Journal of Medicine 1999;340:1471-1475.
