Post on 21-Jul-2020
Complications of Cosmetic TourismMatthew J. Carty, MD
Staff Surgeon, Division of Plastic Surgery
Brigham and Women’s Hospital
Associate Professor of Surgery
Harvard Medical School
I have no disclosures or conflicts of interest.
Medical Tourism
The practice of traveling to another
country in order to receive health
care
Top Medical Tourism
Destinations
• Costa Rica
• India
• Malaysia
• Mexico
• Singapore
• South Korea
• Taiwan
• Thailand
• Turkey
• United States
Approximate worldwide value: $439
billion/year
Source: Dalen JE, Alpert JS. Medical tourists: Incoming and outgoing. Am J Med (2019); 123(1): 9-10
Most Frequent
Conditions Treated in
Medical Tourism
• Dentistry
• Cosmetic surgery
• Cardiac
conditions
• Infertility
• Weight loss
• Dermatology
• Organ transplants
• Spine surgery
Source: Dalen JE, Alpert JS. Medical tourists: Incoming and outgoing. Am J Med (2019); 123(1): 9-10
Source: Alizadeh K. Commentary on: Complications after cosmetic surgery tourism. Aesth Surg Journ (2017); 37(4): 483-484
VQ + S
$=
(VALUE)
(QUALITY) (SERVICE)
(COST)
Promise of Reduced
Cost
• Limited or no prospects to
meet physician or specialist
nurse in advance
• Limited or no prospects of
having standard follow up
• No clear definition as to
who will manage
postoperative
complications or revision
surgery
Source: Miyagi K, Auberson D, Patel AJ et al. The unwritten price of cosmetic tourism: An observational study and cost analysis. J Plast
Recon Aesth Surg (2012); 65: 22-28
Promise of Equivalent or Improved Outcomes?
• Consent
• Agency
• Responsibility
LIMITATIONOUTCOME
PARAMETER
Source: Miyagi K, Auberson D, Patel AJ et al. The unwritten price of cosmetic tourism: An observational study and cost analysis. J Plast
Recon Aesth Surg (2012); 65: 22-28. Ross KM, Moscoso AV, Bayer LR et al. Plastic surgery complications from medical tourism treated in
a U.S. academic medical center. Plast Reconstr Surg (2018); 141: 517e
Source: Miyagi K, Auberson D, Patel AJ et al. The unwritten price of cosmetic tourism: An observational study and cost analysis. J Plast
Recon Aesth Surg (2012); 65: 22-28. Ross KM, Moscoso AV, Bayer LR et al. Plastic surgery complications from medical tourism treated in
a U.S. academic medical center. Plast Reconstr Surg (2018); 141: 517e
Complication
Rate
Number of Patients
with Complications
Number of Patients
Treated
=
Source: Klein HJ, Simic D, Fuchs N et al. Complications after cosmetic surgery tourism. Aesth Surg Journ (2016); 47(4): 474-482
Source: Schnabel D, Esposito DH, Gaines J et al. Multistate US outbreak of rapidly growing mycobacterial infections associated with
medical tourism to the Dominican Republic, 2013-2014. Emerg Infec Dis (2016); 22(8): 1340-1347
• M. abscessus and M.
fortuitum among most
common species
• Notoriously resistant to most
antibiotics
• Most frequently detected in
nonsterile water sources
• Prolonged (24 day) incubation
period
• Classic cutaneous symptom:
painful nodules that develop
into persistent draining
abscesses
• Less frequent systemic signs
Rapidly Growing Mycobacterium
Rapidly Growing Mycobacterium
Source: Ross KM, Moscoso AV, Bayer LR et al. Plastic surgery complications from medical tourism treated in a U.S. academic medical
center. Plast Reconstr Surg (2018); 141: 517e
Source: Schnabel D, Esposito DH, Gaines J et al. Multistate US outbreak of rapidly growing mycobacterial infections associated with
medical tourism to the Dominican Republic, 2013-2014. Emerg Infec Dis (2016); 22(8): 1340-1347
Source: Gaines J, Poy J, Musser KA et al. Nontuberculous mycobacteria infections in U.S. medical tourists associated with plastic surgery
– Dominican Republic, 2017. MMWR (2018); 67(12): 369-370
Source: Schnabel D, Esposito DH, Gaines J et al. Multistate US outbreak of rapidly growing mycobacterial infections associated with
medical tourism to the Dominican Republic, 2013-2014. Emerg Infec Dis (2016); 22(8): 1340-1347
• Incision and drainage
• Debridement
• Delayed closure or skin
grafting
• Implant removal
• Image-guided drainage
• Prolonged antibiotic
therapy (>3 months)
Treatment Requirements
Institutional Costs
Miyagi et al
Klein et al
• £10,878 loss per patient (UK)
• $1,300 gain per patient
(Switzerland)
STUDY FINDING
Source: Ross KM, Moscoso AV, Bayer LR et al. Plastic surgery complications from medical tourism treated in a U.S. academic medical
center. Plast Reconstr Surg (2018); 141: 517e
Personal Costs
• Pain
• Compromised mobility
• Permanent disfigurement
• Social isolation
• Financial strain
• Lost productivity
• Remorse
Mortality
Guidance, Warning
and Oversight
• CDC
• ASPS
• ISAPS
• AMA
• TJC
Estimated Global Medical Tourism Market Size by
Country
2015-2026(in $US billions)