Complications of Cosmetic Tourism Treated in the US
Phoebe McAuliffe1, Tessa Muss1, Ankoor Talwar1, Abhishek Desai1, Robyn Broach1, John Fischer1
1University of Pennsylvania, Philadelphia, PA
Introduction: The number of patients seeking cosmetic surgical procedures abroad, “cosmetic tourism” is increasing, driven by perceived affordability, shorter wait time, and familiarity with the host country. When US patients seek care abroad, short stays and lack of follow-up may lead them to seek treatment for complications back at home. We present a review of the literature of cosmetic tourism complications treated by US physicians.
Methods: Web of Science, Cochrane, Embase, Scopus and PubMed were searched using keywords to capture the topics of “cosmetic surgery” and “medical tourism.” Two independent reviewers conducted screening and a 3rd reviewer resolved conflicts. Included articles were in English, full-text, and reported complications of patients receiving postoperative care in the United States after undergoing cosmetic surgical procedures abroad.
Results: 665 articles screened for inclusion/exclusion criteria. Ultimately 21 articles were included, reporting complications of 209 unique patients. Of the patients with reported demographics, 97.1% were female, 1% were male and 1.5% were transgender females, with an age range of 19-64. 82.8% of the surgeries took place in the Dominican Republic, 4.3% Mexico, 3.3% Colombia and 9.6% other or unknown. The most common surgical procedure was abdominoplasty (39.3%), followed by liposuction (21.7%), breast augmentation (15.1%) and buttock augmentation (6.6%). Overall reported complications included 117 infections (56.0%), 9 seromas (4.3%), 7 embolic complications (3.3%), 16 granulomatous reactions to silicone (7.7%) and 2 retained foreign objects (1.0%). The majority of reported patients underwent a surgical management for their complications (55.9%). Thirteen papers exclusively reported infectious complications, including surgical site infection and abscess. Ten studies reported non-tuberculous mycobacterial (NTM) infections, with treatments including extensive operative debridement and long-term antibiotics. Antibiotic regimens involved linezolid, amikacin, imipenem and tigecycline, among others. Complications of these antibiotic treatments included severe GI distress and hearing impairment, as well as indirect costs of long-term intravenous infusions. When reported, costs of complication management ranged from $38,178-$154,700. Insurance information was available for 94 patients, 60% had Medicaid, 21.3% had commercial, 9.6% had Medicare and 5.3% had no insurance.
Conclusions: US physicians treat a range of complications from surgical procedures performed abroad, with potentially devastating outcomes. Life-threatening infections, emboli and significant scarring as well as antibiotic reactions and financial devastation are all consequences of these procedures. Much of the published literature on this topic focuses on NTM infections, requiring a long treatment period and high rate of surgical management.
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