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Invited Commentary
July 2014

The Gap in Patient Protection for Outpatient Cosmetic Surgery

Author Affiliations
  • 1Department of Public Health and Epidemiology, University of Maryland School of Medicine, Baltimore
  • 2Hospital Epidemiology, Veterans Affairs Maryland Healthcare System, Baltimore
JAMA Intern Med. 2014;174(7):1142-1143. doi:10.1001/jamainternmed.2014.441

In September 2012, a 59-year-old woman died in the hospital shortly after undergoing tumescent liposuction at a medical spa for cosmetic surgery in suburban Maryland. As her sister reported, “We never expected her to die from something…that’s so simple.”1 Astute physicians reported her case to the Maryland Department of Health and Mental Hygiene, Baltimore, prompting an investigation that identified 4 confirmed cases and 9 suspected cases of patients with severe invasive group A Streptococcus infections related to this outpatient facility and another owned by the same company in Pennsylvania. Each of the affected patients had surgery that was performed by a physician who was not board certified in plastic surgery and, as was later determined, was colonized with group A Streptococcus and likely experienced a Streptococcal hand cellulitis at the time procedures were performed on 3 patients. The technician working on each of the cases was also colonized with group A Streptococcus (both the surgeon and the technician harbored the identical genotype of the bacteria that had infected patients). Three other patients were hospitalized with necrotizing fasciitis. They required a median of 19 days in the hospital, with 2 to 6 surgical debridements per patient. This outbreak ended with the closure of the outpatient cosmetic surgery facility in Maryland and the temporary suspension of liposuction at the facility in Pennsylvania until infection prevention practices were improved.

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