Patient Safety in Plastic Surgery . Edited by V. Leroy Young, M.D., F.A.C.S., and Richard Botney, M.D. St. Louis, Missouri, Quality Medical Publishing, Inc., 2009. Pages: 621. Price: $275.00.
Patient safety has nearly become its own field of study with the growing attention it has received during the past decade. It can be argued that perioperative patient's safety has improved largely due to advances in anesthesiology; the American Society of Anesthesiologists was the first medical organization to create a foundation to focus on this topic, the Anesthesia Patient Safety Foundation, founded in 1985. Patient Safety in Plastic Surgery is an attempt to view perioperative patient safety from the vantage points of both anesthesiology and plastic surgery. The editor, Dr. V. Leroy Young, makes a good point that cosmetic surgery has a higher visibility than most specialties because it is often completely elective and in the “public spotlight.” Patients are now more fully engaged in their own health care and rightfully want the best quality available—especially because the procedures are elective and generally not covered by insurance plans.
Previous reports on the topic of patient safety in plastic surgery have either overwhelmed the general plastic surgeon with unnecessary detail or made cursory recommendations borrowed from other specialties. Written and edited by a learned group of experts, and even incorporating contributions from an attorney, this book has accomplished its goal without unnecessary detail or superficiality.
The organization of the text is logical, and it transitions smoothly between topics. Throughout the book there are several up-to-date links that are useful for the reader who wishes to obtain more detailed information about this broad topic. Within each chapter, clinical pearls are highlighted and a case scenario is summarized at the end. The book consists of five parts. The first part, “Basic Considerations,” has chapters about patient safety origins and legal ramifications. This first chapter includes concepts of errors, adverse events, and human performance as well as an updated list of Web sites that contain extensive details about implementing safe and reliable medical care safeguards. This section is the only part of the book that is slightly redundant, although it does provide an excellent analysis.
The second part describes medical safety issues, including entire chapters on cardiovascular risks, obstructive sleep apnea, smoking, diabetes, and neurologic considerations. Of these, the chapter on cardiovascular risk is the most inclusive, discussing the 2007 American College of Cardiology/American Heart Association guidelines while explaining the evidence-based debate on perioperative coronary revascularization and the use of preoperative β-blockers. The chapters dedicated to pulmonary management focus on how specific plastic surgery procedures and general anesthesia relate to morbidity and mortality in high-risk patients. The chapter concerning smoking was particularly good, illustrating the increased risk of wound infections and pulmonary morbidity in smokers and establishing a comprehensive approach to smoking cessation. Despite the informative chapters regarding the above medical topics, these chapters do not give treatment paradigms for the pathologies, but instead intend to help plastic surgeons recognize these medial problems so they can request consultations and input from the appropriate specialists.
The third section is about surgical safety issues, many of which we, as anesthesiologists, also consider important (e.g ., postoperative hypothermia). This section is of particular interest to the plastic surgeon and anesthesiologist because this is when the patient is most vulnerable to an adverse event. Interestingly, the first chapter in this surgical section is about psychological evaluation of cosmetic surgery patients and their preoperative motivations and postoperative expectations. The second chapter of this section provides a rather standard review of venous thromboembolism and bleeding. The third surgically related chapter gives an excellent evidence-based approach in preventing surgical wound infections, and it discusses everything from hand hygiene and skin marking pens to instrument sterilization. One of the best chapters in this section describes minimally invasive therapies, such as botulinum toxin (Botox; Allergan, Inc., Irvine, CA) injections and fillers, not only in the United States but also throughout other countries. This chapter also includes excellent figures illustrating complications associated with such therapy.
The fourth section encompasses anesthetic safety issues related to cosmetic surgery. In fact, the airway management chapter by Dr. Richard Botney, the coeditor of the book, is better than those in several primary anesthetic texts because of its depiction of current airway instruments and a thorough explanation of their use, but may be a little too specific for most practicing plastic surgeons. This section also contains specific chapters on malignant hyperthermia, postoperative nausea and vomiting, and patient positioning. A teen death related to malignant hyperthermia at a North American outpatient surgery center made headlines recently. This chapter stresses the importance of having the appropriate kind and amount of medications (such as dantrolene) to treat such an event at an outpatient surgical facility, and it gives detailed guides about what is needed in a malignant hyperthermia cart. The chapter on patient positioning gives a review of physiologic changes during surgical positioning, in addition to invaluable pictures of potential pitfalls.
Part five is a summary chapter that succinctly ties together many of the preceding ideas from medical, surgical, and anesthetic points of view.
With its beautifully refined leather binding and hardy construction, it is not surprising that Patient Safety in Plastic Surgery was edited by a cosmetic surgeon. The intended audience of this book is practicing plastic surgeons, as stated in the preface. This book is an excellent resource for practicing physicians involved in the care of patients undergoing plastic surgery, and it emphasizes the current commitment to safety as a top-level priority in all areas of medicine.
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