Cosmetic surgery patients at risk from ‘conscious sedation’: peak body

By medical reporter Sophie Scott

Australian patients undergoing cosmetic surgery procedures face serious complications if it is done in office-based facilities without the proper equipment, experts have warned.

The Australian Society of Plastic Surgeons has called for nationally consistent guidelines for patients having cosmetic procedures as part of its submission to the Medical Board of Australia’s review of cosmetic surgery.

The organisation said it was particularly concerned about the use of “conscious sedation”, where patients are given large doses of anaesthetics.

The society’s president, Associate Professor Hugh Bartholomeusz, said patient safety was a top priority.

“We are particularly concerned about office-based surgical procedures that use high volume local anaesthesia or ‘conscious sedation’ [and] fly under the radar in terms of accreditation and audit,” he said.

Conscious sedation is broadly defined by the US National Library of Medicine as “a combination of medicines to help you relax (a sedative) and to block pain (an anaesthetic) during a medical or dental procedure. You will probably stay awake but may not be able to speak”.

In Australia, any doctor can call themselves a “cosmetic surgeon” without undertaking any additional training or supervision.

Many procedures by cosmetic surgeons are performed in office-based cosmetic facilities, some of which do not have hospital equipment to deal with patient emergencies.

“We believe patients are largely unaware of the inherent differences in safety and quality control associated with surgical procedures performed at hospitals and day procedures compared to doctor’s offices,” Associate Professor Bartholomeusz said.

Cosmetic surgery in Australia largely unregulated

Cosmetic surgery is largely unregulated, including the amount and types of anaesthetics used by various practitioners.

The Medical Board of Australia has proposed a number of changes which could see mandatory cooling off periods.

The Society of Plastic Surgeons wants:

  • independent accreditation of office-based premises conducting surgery
  • credentialling of clinical staff, infection control and minimum quality and audit requirements to ensure that resuscitation equipment and immediate transfer to a hospital is available where surgery is performed using more than low amounts of local anaesthetic.

Plastic surgeons want significant changes to the current system, saying the lack of regulation of office-based surgery poses an unacceptable risk to patient safety.

“The simplest mechanism would be to adapt day procedures centres [or] day hospital legislation to include office-based surgery with requirements including independent accreditation of facilities,” Associate Professor Bartholomeusz said.