Delayed Versus Early Surgical Management of Complications from Medical Tourism
Kian Adabi, BA1, Carrie S. Stern, MD2, Katie E. Weichman, MD1, Evan S. Garfein, MD1, Oren M. Tepper, MD1, J Alejandro Conejero, MD2.
1Albert Einstein College of Medicine, Bronx, NY, USA, 2Albert Einstein College of Medicine, Bronx,, NY, USA.
Authors: Kian Adabi, Carrie S. Stern, Katie E. Weichman, Evan S. Garfein, Oren M. Tepper, J. Alejandro Conejero
Title: Delayed Versus Early Surgical Management of Complications from Medical Tourism
Purpose: Increasing numbers of patients seek to have cosmetic surgery abroad. Complications that may result from these procedures have a significant cost to the US healthcare system. The purpose of this study is to evaluate the incidence of hospital readmission after failed conservative management when treating these complications and to better understand its impact on patient morbidity and US healthcare costs.
Methods: A single center retrospective review was conducted from January 2013 to January 2017 using Clinical Looking Glass, a software application that mines medical records (IRB 2015-5004). A cohort of patients presenting with complications from aesthetic procedures performed abroad was generated. Demographical information, complications and treatment of those complications were reviewed. Two study groups were generated, group 1 patients who underwent conservative management initially followed by more aggressive treatment, while group 2 patients who underwent surgical management on initial presentation. The number of interventions and type of intervention were documented. The time course of treatment including the time to presentation and time from presentation to operative procedure was also assessed. The number of patients who underwent drain placement with or without subsequent surgery was evaluated. Cost analysis using ICD9 codes was conducted to compare the cost difference of treating the two groups.
Results: Fifty patients, all female were identified with an average age of 36 years (range 20-61; SD = 11.5). Thirty-one patients (62%) presented with soft tissue infections. Fifteen patients had positive wound cultures. Twenty-two patients with soft tissue infections were initially managed conservatively (group 1) on first admission, while 9 patients underwent operative debridement at first admission (group 2). Fifteen of 22 patients (68%) that were initially treated conservatively subsequently required readmission. In contrast, 4 of the 9 patients (44%) treated surgically initially required readmission despite higher morbidity on presentation. The average cost of treating those treated conservatively initially was $16,548 (range $4,583-$40,183), while those with early surgical intervention had an average of cost 14,334 (range $2,586-$32,897). Average time to OR from presentation was 38.5 days. Twenty-three patients required hospital admission and the average length of stay was 11.8 days. Twenty-four patients received antibiotics, and all patients that went to the OR had received antibiotics prior.
Conclusion: Complications from medical tourism can be significant. These often require aggressive treatment at initial presentation. There is a high incidence of failure with conservative management leading to readmission, increased costs and poor outcomes for patients.
Back to 2017 Program