Plastic & Cosmetic Surgery

Requires Standards 1–7 verified first

3 criteria

ALL YES Standard likely met. ANY PARTIAL Improvement plan required. ANY NO Blocks accreditation until resolved.

REFERENCES

1. [86] Murphy RX Jr, Alderman A, Gutowski K, Kerrigan C, Rohrich RJ, Byrd HS, et al. Evidence-based practices for thromboembolism prophylaxis: summary of the American Society of Plastic Surgeons Venous Thromboembolism Task Force Report. Plast Reconstr Surg. 2012;130(1):168e-175e — establishes physician-completed Caprini risk scoring as the standard for VTE prophylaxis decisions in plastic surgery, given documented unreliability of patient self-assessment.

Blood clot risk after plastic surgery procedures — particularly body contouring — is genuinely well-documented, and the evidence specifically shows patients cannot reliably calculate their own risk score, with roughly a quarter of patient-completed scores leading to the wrong prophylaxis decision entirely.

1 The score is physician-completed for major procedures but skipped for shorter or perceived lower-risk cases.

The 60-minute general anesthesia threshold, not a subjective sense of procedure risk, is what determines whether scoring applies.

2 The score is completed but prophylaxis decisions default to a standard approach regardless of the specific category.

The whole value of risk stratification is lost if prophylaxis doesn't actually vary by category.

3 Reassessment happens when the surgeon proactively remembers, without a defined trigger.

A defined trigger provides more reliable reassessment than dependence on individual memory.

Week 1 Review current VTE risk assessment practice for physician completion versus patient self-report.

Week 2 Establish or reinforce genuine linkage between risk category and prophylaxis decision.

Week 3 Define a specific trigger for reassessment when procedure scope changes.

Ongoing Audit risk score completion and prophylaxis decision consistency periodically.

Ask specifically who completes the risk score — check for patient self-report specifically.

This is a documented, specific failure mode worth checking directly, not assuming.

Ask for a real example of a high-risk score and the resulting prophylaxis decision.

A real example reveals whether the score genuinely drives decisions, not just gets recorded.

ALL YES Standard likely met. ANY PARTIAL Improvement plan required. ANY NO Blocks accreditation until resolved.

REFERENCES

1. [87] Office-based anesthesia safety standards equivalent to hospital-based operating room requirements, including qualified personnel and defined emergency transfer protocols, are established practice for reducing the documented elevated risk associated with office-based surgical anesthesia.

Office-based cosmetic surgery has a documented history of serious adverse events specifically linked to inadequate anesthesia monitoring and unprepared emergency response — the setting being an office rather than a hospital doesn't reduce the real risk anesthesia carries, and the safety standard shouldn't be reduced either.

1 Personnel qualifications are appropriate but monitoring equipment is older or less comprehensive than current hospital standard.

Equipment standards, not just personnel qualifications, need to genuinely match hospital equivalence.

2 A transfer protocol exists but hasn't been tested or reviewed recently.

An untested protocol may not translate smoothly into real action during an actual emergency.

3 The receiving facility was named some time ago but the relationship hasn't been reconfirmed as still active.

A relationship needs to remain genuinely active, not just historically established.

Week 1 Review current anesthesia personnel qualifications and monitoring equipment against hospital-equivalent standards.

Week 2 Address any gap in personnel qualification or equipment equivalence.

Week 3 Establish or reconfirm a specific emergency transfer protocol with a named facility.

Ongoing Periodically reconfirm the transfer relationship remains active.

Ask to see actual monitoring equipment and compare against hospital operating room standard.

Direct physical comparison reveals whether equivalence is genuine, not assumed.

Ask for a real, recent example of the transfer protocol being used or tested.

A real example, or its honest absence, reveals whether the protocol genuinely functions.

ALL YES Standard likely met. ANY PARTIAL Improvement plan required. ANY NO Blocks accreditation until resolved.

REFERENCES

1. [88] Defined, pre-scheduling patient selection criteria for office-based surgical safety, distinct from same-day clinical assessment, are established practice for reducing the documented risk associated with proceeding despite contraindicating patient factors.

Certain patient factors genuinely change the safety calculus of performing a procedure in an office-based setting versus a hospital, and the safest point to identify this is well before the day of surgery — assessing suitability only once the patient has already arrived, prepared, and is emotionally invested in proceeding makes an honest exclusion decision far harder to make.

1 Criteria exist and are generally applied but aren't consistently checked before scheduling confirmation.

The value of early assessment is lost if it happens after scheduling is already confirmed.

2 BMI and comorbidities are considered but combined procedure duration limits aren't specifically tracked.

Combining multiple procedures can meaningfully extend total anesthesia time beyond any single procedure's individual risk profile.

3 The practice believes it would decline an unsuitable patient but has no real example to demonstrate this.

An untested belief and a demonstrated, real practice are different things.

Week 1 Review current patient selection timing against a genuine pre-scheduling standard.

Week 2 Establish specific, named exclusion criteria covering BMI, comorbidities, and duration limits.

Week 3 Build the criteria check into the scheduling process itself, before confirmation.

Ongoing Document any case where criteria result in a decline or redirection.

Ask for the specific BMI threshold and duration limit used, not a general description of careful patient selection.

Specific, named figures reveal a genuine standard rather than case-by-case judgement alone.

Ask for a real example of a declined or redirected patient.

A real example, or its honest absence, is the clearest evidence of whether criteria have genuine teeth.