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| Patients should know the dangers of going under the knife | |
By ANDRÉ PICARD PUBLIC HEALTH REPORTER; With files from Gloria Galloway Friday, April 16, 2004 - Page A15 |
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Every surgeon repeats the phrase like a mantra: "All surgery entails risks." From dental surgery through to heart transplants, there are inherent and not always predictable risks related to going under the knife: Reaction to anesthetic, blood loss, allergies and even genetic predisposition to these complications.
"There's no such thing as a routine operation," said Wayne Perron, a Calgary plastic surgeon. "Every procedure and every patient is different."
Generally speaking, however, aesthetic plastic surgery, like that undergone by Cinar Corp. co-founder Micheline Charest, tends to have a much lower risk of complications. That is principally because the surgery is elective, meaning it is done on healthy people whose family and medical history can be examined ahead of time.
Ms. Charest, 51, was in good physical condition, including being a marathon runner. But there are several elements of her case that, though they are unconfirmed, raise red flags. She was reportedly set to undergo three different procedures: a rhytidectomy (facelift), mastopexy (breast lift) and liposuction (the suctioning out of fat).
While it is common for patients to undergo these three procedures, or more, many surgeons refuse to do more than one operation at a time because of the stress it places on the body, and because the risk of complications is greatly increased.
All three operations can be done using local anesthetic and sedation. But some surgeons prefer to use general anesthesia, as in Ms. Charest's case.
While there is no hard and fast rule about how long a person can be anesthetized, generally speaking, shorter is better. That is because lying immobile for long periods of time can increase the risk of blood clots developing, which can trigger a stroke. Almost all deaths during plastic surgery are related to stroke.
To minimize complications during longer surgeries, patients are often fitted with compression stockings (which aid blood flow) and they are given blood thinners. But blood thinners make it more difficult to control bleeding, which can lower blood pressure and trigger a heart attack.
Ms. Charest also had an additional risk factor: family history. Her father, André Charest (who was himself a plastic surgeon), died during hip surgery in 1995. He was only 69 years old.
There is strong evidence that there is a genetic predisposition to having an allergic reaction to anesthesia. Asking about the history of immediate family members under anesthesia is standard before all surgery.
In Canada, the chances of a healthy person dying as a result of anesthesia are between one in 200,000 and one in 400,000, according to the Canadian Anesthesiologists' Society. Those are about the same odds as dying in a plane crash.
The Clinique Notre-Dame, where Ms. Charest underwent her surgery, said yesterday that it was the first death at the facility in more than 3,200 surgeries.
Dr. Robert Stubbs of Toronto, one of Canada's most high-profile plastic surgeons and internationally renowned for penis enhancements, said he has never lost a patient among the thousands he has operated on.
But he said a major problem for surgeons is patients who fail to fully disclose medical details, such as use of medication and supplements. Dr. Stubbs said his worst experience was with a patient who almost bled out during a facelift. She had failed to disclose she was taking blood thinners.
"It was a real humbling experience and an eye-opener," he said. "She ended up in the intensive care unit."
In most provinces, stand-alone clinics, where most plastic surgery is performed, have to meet the same standards as hospitals in terms of resuscitation equipment such as heart defibrillators.
There were around 8.5 million cosmetic plastic surgery procedures done in the United States last year. In Canada, there are no data because private medical centres, where most of the surgery is performed, are not obliged to report.
Popular procedures
A look at how the popularity of these common surgical and nonsurgical cosmetic procedures has grown over six years in the U.S.:
Botox injection
2003: 2,272,080
1997: 65,157
Chemical peel
2003: 722,248
1997: 481,227
Collagen injection
2003: 620,476
1997: 347,168
Liposuction
2003: 384,628
1997: 176,863
Breast augmentation
2003: 280,401
1997: 101,176
Eyelid surgery
2003: 267,627
1997: 159,232
SOURCE: AMERICAN SOCIETY FOR AESTHETIC PLASTIC SURGERY