Three Decades of Outpatient Plastic Surgery Safety: A Review of 42,720 Consecutive Cases.

[BACKGROUND] Outpatient plastic surgery offers cost-effective solutions and enhanced privacy, but demands careful patient assessment for suitability and vigilant anticipation of adverse events. To provide recommendations to enhance patient safety in outpatient settings, this study analyzed more than 40,000 consecutive cases spanning 3 decades.

[METHODS] The authors retrospectively reviewed all consecutive cases completed by board-certified plastic surgeons at an accredited outpatient surgical center between 1995 and 2023. Patient demographics, operative details, and postoperative complications were recorded to determine risk factors for complications and inpatient admissions. A subgroup analysis for procedures of the face, breast, and body was also performed.

[RESULTS] A total of 42,720 consecutive cases were performed, with an overall complication rate of 0.74% ( n = 318). Patients who experienced a venous thromboembolism or an inpatient transfer, had a higher body mass index ( P < 0.05), had a longer operative duration ( P < 0.05), and were more likely to have undergone combined procedures ( P < 0.05) were compared with those who did not. Undergoing a combined procedure was the strongest predictive factor for venous thromboembolism and inpatient admissions (OR, 12.65; OR, 3.73; P < 0.05), followed by longer operative time (OR, 1.45; OR, 1.32; P < 0.05).

[CONCLUSIONS] To the authors' knowledge, this is the largest long-term private practice plastic surgery study in accredited outpatient settings spanning almost 30 years, further confirming that outpatient plastic surgery can be performed in a consistent and safe manner with proper preoperative evaluation and patient optimization. Postoperative monitoring should be considered for high-risk patients, particularly those with a body mass index exceeding 26 kg/m², operative times surpassing 3 hours, lipoaspirate volumes greater than 3 liters, and planned combined procedures-particularly in cases involving abdominoplasty.

[CLINICAL QUESTION/LEVEL OF EVIDENCE] Risk, III.