fat embolism (8.5%), cardiorespiratory failure (5.4%), massive infection (5.4%) and hemorrhage (4.6%). The authors noted a trend in death on the first postoperative night and thus advocated for overnight medical supervision after the procedure.
Potential risks of liposuction under general anesthesia are significantly greater and include deep venous thrombosis or pulmonary embolus, abdominal or other organ perforation, infection, and bleeding.9 A study in 2005 by Coldiron and colleagues reviewed all reported adverse incidents (the death of a patient, serious injury, and subsequent hospital transfer) occurring in an office setting from March 1, 2000, through March 1, 2004, from the Florida Agency for Health Care Administration.9 There were 286 reported office adverse events reported, 77 occurring in association with an office surgical procedure (19 deaths and 58 hospital transfers).9 There were seven complications and five deaths associated with the use of intravenous sedation or general anesthesia.9 There were no adverse events associated with the use of dilute local tumescent anesthesia.9 In contrast, liposuction and/or abdominoplasty under general anesthesia or intravenous sedation were the most common surgical procedures associated with a death or complication.9
Similarly, a recent study in the plastic surgery literature in Germany by Lehnhardt M and colleagues demonstrated a number of severe complications from liposuction performed under general anesthesia in the setting of the operating room.30 These authors performed a retrospective analysis of severe or lethal complications related to cosmetic liposuction in Germany.30 To collect pertinent information, 3500 questionnaires were sent to departments of pathology and forensic medicine, intensive care units, and others.30 After the identification of cases with major complications, the second phase of the investigation consisted of interviews with the physicians performing the liposuction.30 2,275 questionnaires (65%) were returned. The analyzed data showed 72 cases of severe complications, including 23 deaths following cosmetic liposuction in a 5-year period from 1998 to 2002.30 The most frequent complications were bacterial infections such as necrotizing fasciitis, gas gangrene, and different forms of sepsis.30 Further causes of lethal outcome were hemorrhages, perforation of abdominal viscera, and pulmonary embolism.30 In all cases of serious complication, aggressive volumes of fat were removed with liposuction under general anesthesia, including a case where 24 L of fat were removed in a patient who died after liposuction from complications of necrotizing fasciitis and gas gangrene.30 The authors concluded that major risk factors for the development of severe complications from liposuction included insufficient standards of hygiene, infiltration of multiple liters of tumescent solution, permissive postoperative discharge, and selection of unfit patients.30 The lack of surgical experience was a contributing factor, particularly regarding the timely identification of developing complications.30
There are several additional cases reported in the literature of fasciitis after liposuction, including a case of group A streptococcal fasciitis complicating tumescent liposuction.31 In this case, a 62-year-old woman presented 8 days after submental liposuction and a platysmal plication procedure with signs and symptoms of cervical fasciitis.31 Microbiological analysis confirmed a group A streptococcal infection. By using early aggressive medical and surgical treatments, the disease was arrested before the onset of any necrotizing process.31 A high index of suspicion is required to make an early diagnosis of this potentially disfiguring and life-threatening infection.31
