Unregulated office-based cosmetic surgery a risk to patient safety

The Australian Society of Plastic Surgeons (ASPS) is calling for nationally consistent regulation of office-based cosmetic surgery and enforceable guidelines around the use of anaesthetic in these settings, arguing that the current lack of oversight poses an unacceptable risk to patient safety.

In its submission to the Medical Board of Australia’s public consultation on cosmetic surgery guidelines, the Australian Society of Plastic Surgeons says there is a gap in quality and safety systems relating to office-based surgery, and the qualifications of people performing procedures, which needs to be addressed to bring them into line with standards currently required of hospitals and day procedure centres.

Driven by market opportunity, an increasing number of doctors are turning their hands to cosmetic surgery with more sophisticated operations being undertaken in doctors’ offices around Australia.

“Patient safety is our priority and we are particularly concerned that office-based surgical procedures that use high volume local anaesthesia or ‘conscious sedation’ fly under the radar in terms of accreditation and audit,” said the ASPS President, Associate Professor Hugh Bartholomeusz OAM RFD.

Currently there are no regulations around office-based surgeries and no requirement for credentialing of a medical practitioner who undertakes operations in these settings.

“Additionally we are conscious that consumers are ill-equipped to discern whether the doctor they choose for their cosmetic surgery is adequately trained to perform their procedure. The ASPS recently launched it’s “Think Over before You Make Over” campaign prompted by a similar campaign in the UK and a British Association of Plastic, Reconstructive and Aesthetic Surgeons survey that revealed of the two million British considering cosmetic surgery each year, a quarter don’t check the credentials of their surgeon. It is likely that an Australian survey would yield similar results,” said Associate Professor Bartholomeusz.

“In Australia ‘cosmetic surgery’ is a term used to describe one of the sub-specialties of Plastic Surgery. Specialist Plastic Surgeons, having completed medical school, undertake at least a further eight years of training, five of which constitute the formal Plastic Surgery training program which includes a large component of cosmetic surgery experience, to qualify as a Fellow of the Royal Australasian College of Surgeons (RACS). Our training program is recognised as world-class.”

However, uniquely in Australia, non-surgeons are undertaking cosmetic surgery without qualifying as a Fellow of RACS and undertaking the rigorous cycle of continuing education and review that entails.

“Consumers should be aware that there is no difference between cosmetic surgery and other surgery in regard to healing time, risk of complications and surgical and anaesthetic risk – it is a serious, technically demanding surgical discipline and Plastic Surgeons are uniquely qualified to undertake this work,” said Associate Professor Bartholomeusz.

We believe patients are also largely unaware of the inherent differences in safety and quality control associated with surgical procedures performed at hospitals and day procedure centres compared with doctor’s offices.

“It is critical that basic standards be required of all facilities where surgery of any description is undertaken and the simplest mechanism would be to adapt day procedure centres/day hospital legislation to include office-based surgery with nationally consistent requirements including independent accreditation of the facilities,” said Associate Professor Bartholomeusz.

“These would include independent accreditation of these premises, credentialing of clinical staff, infection control and minimum quality and audit requirements that for example, ensure that resuscitation equipment and immediate transfer to a hospital is available where surgery is performed using more than low volume local anaesthetic.”
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