From the Montefiore Medical Center, Albert Einstein College of Medicine.
Plast Reconstr Surg. 2020 May;145(5):1147-1154. doi: 10.1097/PRS.0000000000006728.
Complications from medical tourism can be significant, requiring aggressive treatment at initial presentation. This study evaluates the effect of early surgical versus conservative management on readmission rates and costs.
A single-center retrospective review was conducted from May of 2013 to May of 2017 of patients presenting with soft-tissue infections after cosmetic surgery performed abroad. Patients were categorized into two groups based on their management at initial presentation as either conservative or surgical. Demographic information, the procedures performed abroad, and the severity of infection were included. The authors' primary outcome was the incidence of readmission in the two groups. International Classification of Diseases, Ninth Revision; International Classification of Diseases, Tenth Revision; and CPT codes were used for direct-billed cost analysis.
Fifty-three patients (one man and 52 women) presented with complications after procedures performed abroad, of which 37 were soft-tissue infections. Twenty-four patients with soft-tissue infections at initial presentation were managed conservatively, and 13 patients were treated surgically. The two groups were similar in patient demographics and type of procedure performed abroad. Patients who were managed conservatively at initial presentation had a higher rate of readmission despite having lower severity of infections (OR, 4.7; p = 0.037). A significantly lower total cost of treatment was shown with early surgical management of these complications (p = 0.003).
Conservative management of complications from medical tourism has resulted in a high incidence of failure, leading to readmission and increased costs. This can contribute to poor outcomes in patients that are already having complications from cosmetic surgery.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
医疗旅游相关并发症可能较为严重，需要在初次就诊时进行积极治疗。本研究评估了初始治疗时采取手术与保守治疗策略对再入院率和费用的影响。
回顾性分析了 2013 年 5 月至 2017 年 5 月期间因出国整形术后发生软组织感染而就诊的患者。根据初次就诊时的治疗方法将患者分为保守治疗组和手术治疗组。收集患者的人口统计学信息、国外手术操作及感染严重程度等资料。主要结局指标为两组患者的再入院率。采用国际疾病分类第 9 版和第 10 版（ICD-9、ICD-10）和 CPT 编码进行直接计费成本分析。
53 例（1 例男性，52 例女性）因出国手术相关并发症就诊，其中 37 例为软组织感染。24 例初次就诊时采用保守治疗，13 例采用手术治疗。两组患者的人口统计学资料和国外手术类型相似。尽管感染严重程度较低，但保守治疗的患者初次就诊时再入院率更高（OR，4.7；p = 0.037）。早期手术治疗这些并发症可显著降低总治疗费用（p = 0.003）。
对医疗旅游相关并发症采取保守治疗导致较高的治疗失败率，从而导致再入院和费用增加。这可能会导致已因整形手术出现并发症的患者出现较差的结局。
临床问题/证据水平：治疗性，III 级。
