Complications of Cosmetic Tourism · Source: Miyagi K, Auberson D, Patel AJ et al. The unwritten...
Transcript of Complications of Cosmetic Tourism · Source: Miyagi K, Auberson D, Patel AJ et al. The unwritten...
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)