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Is Cosmetic Surgery Tourism Worth It? A Cost Analysis of Nontuberculous Mycobacterium Surgical Site Infections Contracted Abroad
James C. Lee, MD, Kerry A. Morrison, BA, Michelle M. Chang, BS, Jeffrey A. Ascherman, MD, Christine H. Rohde, MD.
Columbia University Medical Center, New York, NY, USA.

BACKGROUND: Cosmetic surgery tourism has become increasingly popular despite many associated risks. Outbreaks of nontuberculous Mycobacterium surgical site infections in countries around the world have been particularly notable since it was reported by the Centers for Disease Control in 2004. While these difficult-to-treat infections are concerning to patients and providers, their economic impact is not well-defined in the literature. We sought to investigate the costs incurred by patients and the healthcare system from cosmetic surgeries performed abroad.
METHODS: A retrospective review of all patients presenting to Columbia University Medical Center and managed by the Division of Plastic Surgery from 2013 to 2014 with culture-proven nontuberculous Mycobacterium surgical site infections following cosmetic surgery outside the United States was performed. Data including patient demographics, location of original surgery, type of surgery, treatments rendered, clinical course, and complications were gathered from clinical charts. Billing information for all medical treatments associated with the presenting infection were collected from the hospital billing department. Each patient was individually interviewed to ascertain his or her estimated travel cost, cost of cosmetic surgery, cost of accommodations, history of present illness, and impact on daily life including time to return to work. Cost analysis was performed to identify the private and societal costs associated with each infection.
RESULTS: Data from ten patients were collected and analyzed. All 10 patients were women with an average age of 40 years old (range 23 to 59 years), and surgeries were performed in the Dominican Republic for nine patients and Colombia for one patient, respectively. Cosmetic procedures performed overseas included combinations of abdominoplasty, breast augmentation, and liposuction. Management of mycobacterial infections resulted in an average of $96,949.81 in total medical charges. The opportunity cost of missed work was calculated to be $12,037.50 with a mean return to work time of 5.35 months. Total initial patient savings from cosmetic surgery tourism was approximately $5,050, although this was cut to $3,419 when the costs of airfare and accommodations were considered. The total potential cost to the patient of a single mycobacterial infection was estimated to be greater than $109,587.31, although a portion of this cost is borne by insurers and healthcare providers. Although the incidence of mycobacterial infections abroad is unknown, the potential cost to the patient of contracting an atypical mycobacterium infection alone outweighs the financial benefits of cosmetic tourism if the infection rate exceeds 3.12%. In fact, this value is even lower once all other risks of cosmetic surgery abroad are taken into consideration.
CONCLUSIONS: Atypical mycobacterial infections as a result of cosmetic surgery abroad come at a considerable price to patients and the healthcare system. When the results of our study are taken into consideration with other risks of cosmetic surgery tourism including non-mycobacterium infections, intraoperative complications, pulmonary embolism, post-operative bleeding, and need for reoperation, we can conclude that the financial risks of cosmetic surgery tourism likely far outweigh any anticipated benefits. Our study serves as a platform to facilitate patient and policy discussions in mitigating the risks of cosmetic surgery tourism.

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