Surgical Tourism Research Articles

Aesthetic Surgery Tourism: An Opportunity or a Danger?

Medical and surgical tourism is a rapidly growing phenomenon in post-pandemic Europe. The exodus of patients abroad to perform surgery, especially cosmetic treatments, is spreading recently in industrialized countries. In the social media era, the ease of access to advertising about surgical procedures and their costs favors traveling. However, the information given is not always punctual, and there is often a lack of patient awareness about the risks related to the procedures. The objective of the manuscript is to investigate, through clinical examples, the path that a patient operated on in a non-European country must face once he returns home. From the availability and translation of clinical documentation to the problems encountered in revision surgeries. Thirteen cases of surgical tourism, patients who presented to our department with surgical complications, are investigated. Adverse events occurring during medical treatment abroad raised medico-legal and appropriateness issues, as well as concerns regarding the follow-up of patients. The current literature confirmed the high complication rate: It affects individual patients and the native country's healthcare systems. Therefore, patients must learn more about the dangers of traveling abroad for surgery. Education initiatives in the patient's home country might help achieve this. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Developing an International Framework for Informed Consent in Plastic Surgery: A Focus on Cosmetic Breast Augmentation.

Informed consent is a fundamental pillar of patient rights and is an essential part of good clinical practice. In 2019, the International Confederation of Plastic Surgery Societies launched a survey to collect feedback on informed consent practices, with an aim to develop an international guideline for cosmetic surgery. A 15-question survey was sent to delegates of the International Confederation of Plastic Surgery Societies for dissemination to their national society members. The survey comprised a range of quantitative and qualitative questions. Descriptive and thematic analysis was performed. There were 364 respondents. Over half of the respondents reported no local informed consent policy, whereas others noted national society, specialist college, or government policies. The majority of respondents believed that the performing surgeon should be responsible for obtaining informed consent with at least two face-to-face consultations. Most respondents agreed with a cooling-off period (duration based on procedure type and use of high-risk devices). Regarding cosmetic breast augmentation, the majority of respondents felt that the performing surgeon should be responsible for postoperative management, including cases that occur as part of surgical tourism. Some respondents incorporate financial consent as part of their informed consent practice. Most supported the development of an international informed consent guideline. Informed consent should result from face-to-face consultations with the performing surgeon. There should be a minimum cooling-off period. Postoperative surveillance should be available in all settings. The findings of this survey will help inform an international standardized informed consent guideline for cosmetic surgery.

A Not-So-Glamorous Vacation: The Impact of Cosmetic Surgical Tourism on Patients and the Healthcare System

A Not-So-Glamorous Vacation: The Impact of Cosmetic Surgical Tourism on Patients and the Healthcare System

Instrument Sterilization and Surgical Site Infections in Low and Middle Income Countries

With the recent surge in oftentimes fatal bacterial resistance, surgical site infections (SSI) are now a prominent topic of scholarly discussion. These infections occur due to unsterile surgical practices infiltrating the operating room, and deadly pathogens with it. The developed world has lowered rates of SSI through scrupulous enforcement of CDC sterilization guidelines while low and middle income countries (LMICs) continue to fall victim to inefficient sterilization. LMICs often don't have the resources to reach these CDC guidelines and as a result endure surgical instrument contamination. Currently, there is a gap in funding and research related to the state of surgical instrument sterilization. This study aims to reveal first hand data regarding the gap in adherence to CDC sterilization guidelines for a variety of LMICs. Data was collected through virtual interviews with surgeons or surgical technologists globally. Interview responses were later scored for adherence to the CDC guidelines and correlated with rates of SSI per country. Results showed that the adequacy of surgical instrument sterilization processes (SP) in hospitals is directly correlated to SSI rates in LMICs. A one tailed test with a flow of SP adherence to SSI prevalence rendered the following strong correlation of R squared=0.772. This relationship demonstrates that investments to improve surgical sterilization processing will likely render lower rates of SSI. Lower SSI rates in LMICs could give rise to an increase in surgical tourism, a decrease in expensive treatments for highly resistant bacteria, and ultimately a decrease in surgical morbidity and mortality.

1201 A Systematic Review and Meta-Analysis of Venous Thromboembolism Risk in Surgical Patients with Recent Air Travel

Abstract Aim Venous thromboembolism (VTE) is associated with recent surgery; additionally, long-haul air-travel increases VTE risk. As surgical tourism increases, more patients are flying long distances seeking surgical intervention. This meta-analysis aimed to estimate post-operative VTE risk in the context of recent air-travel. Method Embase, Ovid MEDLINE, Cochrane and Scopus databases were accessed from 1947 to May 2022. Inclusion criteria were any study design with adults undergoing surgical intervention with recent air-travel, reporting VTE incidence. PRISMA guidelines were followed with a registered protocol (PROSPERO:CRD42022323561). Data was extracted independently by two reviewers and pooled using fixed and random effects. Primary outcome was pooled VTE rate; secondary outcomes were pooled rates of deep vein thrombosis (DVT) and pulmonary embolism (PE). ROBINS-I tool was used to assess risk of bias. Results Seven retrospective studies were included, totalling 24,975 patients. Overall odds of VTE in the flying plus surgery group was 1.96 (95%CI 0.54-7.08). For surgery with post-operative flight odds ratio (OR) of VTE was 1.31 (95%CI 0.63-2.71), whilst for surgery with pre-operative flight OR was 7.86 (95%CI 0.23–265.26). Three studies reported DVT/PE incidence specifically. DVT: for surgery and air-travel DVT rate was 0.67% (95%CI 0.31%-1.51%) versus 0.45% (95%CI 0.10%-2.00%) in surgery alone. PE: for surgery and air travel, PE rate was 0.41 (95%CI 0.00%-1.29%) versus 0.55% (95%CI 0.31%-0.86%) for surgery alone. Conclusions Whilst meta-analysis demonstrates that air-travel confers no additional VTE risk for surgical patients, it does not account for confounding factors. Future research should risk score then propensity match participants to generate higher quality evidence.

How to evaluate surgical tourism service organizations in China: indicators system development and a pilot application

BackgroundSurgical tourism is an emerging economic sector, with the most growth potential demonstrated in China's health industry before the COVID-19 pandemic. Surgical tourism accounts for a large part of medical tourism services in China, with high requirements in terms of quality and safety. By contrast, China suffers from insufficient measurement tools and theoretical research. The aim of this study was to develop a set of reliable and feasible indicators by augmenting the Donabedian model to evaluate the quality of surgical tourism services.MethodsA literature review and focus group interview were used to generate indicators for the quality of surgical tourism services. The basic framework of the evaluation system was based on the structure–process–outcome Donabedian model. The screening and weight setting were conducted through an analytical hierarchy process (AHP) and a two-round Delphi consultation with 13 panelists. The validity and reliability of experts were tested by the experts' positive coefficient, authority coefficient, and coordination coefficient. The reliability of the questionnaire was assessed by a pre-test distributed within an International Medical Department of a public hospital in China.ResultsBased on the Donabedian quality theory, a novel evaluation system of surgical tourism service institutions was constructed with three dimensions, nine first-level items and 39 second-level items. The three dimensions consisted of the structure (0.315), process (0.287), and outcome (0.398), with several indicators for each dimension and each indicator was given a weight. Of the two rounds of Delphi consultation, the response rates were 86.67% and 100%. The coordination coefficient of expert opinions in the two rounds of consultation were 0.49 and 0.65 (p < 0.05). For the empirical study, the self-evaluation score of a public hospital was 86, which could rate as a two-star institution.ConclusionsOur evaluation system identified three suitable quality dimensions of surgical tourism services to improve the safety and quality of practical healthcare. It reflects the access criterion of surgical tourism institutions, provides references for the best choice of surgical services for tourists, and can be applied by healthcare managers and policy makers to allocate resources more efficiently and promote more surgical tourism services with international standards.

Current perceptions of ‘Brazilian butt lift’ (BBL) surgery in the UK: A BAAPS-led survey of BAAPS members

BackgroundThe BAAPS advice against Brazilian butt lift (BBL) surgery in the UK was set in October 2018. A Delphi study conducted by BAAPS highlighted the importance of defining current practice and perceptions amongst UK surgeons, as this is currently unknown. ObjectivesTo evaluate BAAPS members’ current practice and perceptions around BBL surgery to ensure patient safety and propose better recommendations. MethodsA BAAPS-commissioned survey was emailed to all BAAPS members through an on-line link. The survey collected quantitative and qualitative information in several domains. ResultsThis survey received a 44% response rate. Of 102 respondents, 32 surgeons undertook BBL surgery before the BAAPS advice to halt it. There was a wide variation in actual fat volumes injected, and in perceptions of what constituted a small or large volume. Virtually all respondents (96.9%) performed only subcutaneous fat injections. There were differences in fat harvest techniques. The majority (66.7%) felt that BAAPS should maintain its recommendation against undertaking BBL surgery until further data became available. Nearly a quarter of 102 respondents (20.6%) had been treated for BBL complications, the majority as a result of surgical tourism. ConclusionsThe survey provides member-reported perception and experience with regard to BBL surgery in the UK. The demand for BBL surgery and its provision should be reassessed in the UK. This information will be analysed with further national and international data to better define and shape the scope of the safety of BBL surgery in the UK. BAAPS will use such data towards the production of future guidance and support for surgeons and patients.

Patient care without borders: a systematic review of medical and surgical tourism.

Medical tourism (MT) is an increasingly utilized modality for acquiring medical treatment for patients globally. This review assimilates the current literature regarding MT, with particular focus on the applications, ethics and economics. A systematic review of MEDLINE and PubMed Central databases for publications relating to MT from 2005 to 2018 yielded 43 articles for this review. Patients seeking elective bariatric, cosmetic and orthopedic surgery abroad are motivated by significantly lower costs, all-inclusive vacation packages and reduced wait times. Complication rates as high as 56% include infection, poor aesthetic and functional outcome and adverse cardiovascular events. Cross-border reproductive care has steadily increased due to less restrictive policies in select countries; however, the depth of research on outcomes and quality of care is abysmal. Stem cell therapy promise treatments that are often not well researched and offer minimal evidence of efficacy, yet patients are drawn to treatment through anecdotal advertisements and a last sense of hope. Transplant surgery sought to decrease wait times carries many of the similar aforementioned risks and may contribute to the practice of organ trafficking in countries with high rates of poverty. Patients and countries alike are motivated by a plethora of factors to engage in the MT industry but may be doing so without accurate knowledge of the quality, safety or potential for economic gain. Safety is of utmost importance to prevent surgical complications and the spread of treatment-resistant bacteria. MT is growing in popularity and complexity. The lack of standardization in its definition and regulation leads to difficulty in epidemiologic and economic analysis and ethical issues of informed consent and health equity. The findings of this review may be used by the stakeholders of MT, including patients and providers, to enhance informed decision-making and quality of care.

Les enjeux du tourisme chirurgical dans le domaine de la chirurgie esthétique

Surgical tourism is a growing phenomenon, causing a surge demand for the management of its complications. In this study, we aimed to evaluate complications that occur after cosmetic breast surgery abroad; and their costs for the public health system. We reviewed the medical files of patients treated in our department for a complication after cosmetic breast surgery outside Switzerland and assessed all complications requiring hospitalization; and estimated the overall medical costs. Over a two-year period, 26patients were treated for 39complications. The main complication was infection (71% of cases), mainly with a multidrug-resistant organism (47%) and atypical mycobacteria. Of the 16 patients with breast prosthesis, 7 implants were removed. The effective average costs incurred for the hospital care of these cases was estimated to 14'724Swiss Francs (∼12'963Euros) per patient. The high rate of multidrug-resistant and mycobacterial atypical infections are a major public health problem. It is necessary to inform patients much better about the risks of surgical tourism. Furthermore, the danger of transfer of multidrug-resistant or atypical germs from abroad should not be overlooked. Physicians should be informed about this risk and take necessary measures for treatment and diagnosis of these complications.

Aesthetic journeys: a review of cosmetic surgery tourism.

Medical tourism has witnessed significant growth in recent years. The emerging trend towards international travel for cosmetic surgical interventions has not previously been reviewed. The current review aims to critically address the scale and impact of cosmetic surgical tourism and to delineate the complication profile of this form of medical tourism. Articles published in the English language on the PubMed database that were relevant to surgical tourism and the complications of elective surgical procedures abroad were examined. Reference lists of articles identified were further scrutinized. The search terms used included combinations of 'surgery abroad', 'cosmetic surgery abroad', 'cosmetic surgery tourism', 'cosmetic surgery complications' and 'aesthetic tourism'. This article critically reviews the epidemiology of cosmetic surgical tourism and its associated economic factors. Surgical complications of selected procedures, including perioperative complications, are described. The implications for travel medicine practice are considered and recommendations for further research are proposed. This narrative literature review focuses on the issues affecting travellers who obtain cosmetic surgical treatment overseas. There is a lack of focus in the travel medicine literature on the non-surgery-related morbidity of this special group of travellers. Original research exploring the motivation and pre-travel preparation, including the psychological counselling, of cosmetic surgical tourists is indicated.

Surgical tourism or ‘cross-border care’?

Going abroad for surgery is often condemned as risky and potentially burdensome to the NHS – who may have to clean up the mess – but is it simply empowered patients making positive choices about their healthcare? George Winter investigates.

Impact of medical tourism on cosmetic surgery in the United States.

Summary:Developing countries have been attracting more international patients by building state-of-the-art facilities and offering sought-after healthcare services at a fraction of the cost of the US healthcare system. These price differentials matter most for elective procedures, including cosmetic surgeries, which are paid for out of pocket. It is unclear how this rise in medical tourism will affect the practice of plastic surgery, which encompasses a uniquely large number of elective procedures. By examining trends in the globalization of the cosmetic surgery market, we can better understand the current situation and what plastic surgeons in the United States can expect. In this article, we explore both domestic and foreign factors that affect surgical tourism and the current state of this industry. We also discuss how it may affect the practice of cosmetic surgery within the United States.

Surgical Tourism: The Role of Cardiothoracic Surgery Societies in Evaluating International Surgery Centers

In the end, ethical principles of autonomy (respect for the individual), beneficence (doing good for the patient), non-maleficence (avoiding harm), and justice (treat all patients fairly) support the patient in doing what she wants to do with her own life. However, thoracic surgical societies are under no obligation to facilitate this practice, given the potential negative consequences to our health care structure, our culture, and our economic well-being.

Patients Without Borders: The Rise of Surgical Tourism

bal P Medical tourism has been discussed previously in this column and elsewhere in the AORN Journal, but it seems timely to revisit the topic. A good starting point is to consider what the term medical tourism means. One definition is travel outside of an individual’s home region or country in pursuit of medical care that is more accessible, of higher quality, of lower cost, or some combination of these. Out-of-pocket expenses are typically met by the patient. The term excludes emergency treatment given to people who become ill when traveling overseas and foreign residents of destination countries. A narrower description refers to medical tourism as the process whereby patients travel to countries other than their own to obtain medical, dental, and surgical treatments at a far lower price and typically combine the trip with a vacation in the destination country. Although members of the medical tourism industry prefer labels such as medical travel or global health care/traveler because of the perceived pejorative nature of medical tourism, the latter term is well entrenched in academic literature and the popular press. Other terms that are in use include medical refugees, medical off-shoring, patient outsourcing, and surgery and sun. Surgical tourism is a more recent addition to the lingua franca.

Detection of a VIM-27-Producing Klebsiella pneumoniae Isolate in a Patient following Surgical Tourism in Greece

Very recently, Papagiannitsis et al. described VIM-27, a new metallo-β-lactamase (MBL) single-point variant of VIM-1, identified in three Klebsiella pneumoniae isolates of sequence type 147 (ST147) recovered at three different Greek hospitals ([6][1]). We report here that VIM-27-producing K.

"Prospects of Medical Tourism - A Study of The Prominent Participants in Hospital And Hospitality Industry in Bangalore and Chennai"

Medical Tourism" is comparatively new in the vast ocean of travel &amp; tourism industry. When we describe Medical Tourism in simple terms, it is a provision of 'cost effective' private medical care in collaboration with the tourism industry for patients needing surgical and other forms of specialized treatment. This process is being facilitated by the corporate sector involved in medical care as well as the tourism industry - both private and public. Unlike other countries, India is a safe place and people are known for their hospitality. It's the most touted healthcare destinations for .Medical or Health tourism has become a common form of vacationing, and covers a broad spectrum of medical services. It mixes leisure, fun and relaxation together with wellness and healthcare.Medical tourism, a rapidly growing sector in the Indian market, which is now being actively, developed by both public and private sector tourism and healthcare organizations. Medical Tourism" diversifies different paradigms, which derive at a common perception - a specialized field of healthcare tourism in general. The technical concoction defines medical tourism as, "Travel from a normal place of residence to a destination at which medical or surgical treatment is provided or performed, and which involves more than one night away from the country of residence". Within this broad field, there are a growing number of specialized sectors of medical tourism, including surgical tourism, wellness and spa tourism, dental tourism and reproductive or fertility tourism. Medical Tourism in simple terms, it is a provision of 'cost effective' private medical care in collaboration with the tourism industry for patients needing surgical and other forms of specialized treatment. This process is being facilitated by the corporate sector involved in medical care as well as the tourism industry - both private and public. Medical tourism is gaining international significance, as more and more patients prefer their treatments abroad. In the developed countries the cost of the treatment and the surgery are far higher than those in the developing countries. So getting medical treatment abroad is economical for the patients without any compromise in the quality of treatment is one of the major concerns. Western patients are increasingly travelling to developing countries for health care and developing countries are increasingly offering their skills and facilities to paying foreign customers. This international trade in medical services has huge economic potential for developing countries and serious implications for health care across the globe.

Feminine Transformations: Gender Reassignment Surgical Tourism in Thailand

Every year, hundreds of transgendered people from the United States, Europe, Asia, Canada, and Australia travel to Thailand to undergo cosmetic and gender reassignment surgeries (GRS). Many GRS clinics market themselves almost exclusively to non-Thai trans women (people assigned a male sex at birth who later identify as female). This article draws on ethnographic research with patients visiting Thailand for GRS to explore how trans women patients related their experience of medical care in Thailand to Thai cultural traditions, in particular “traditional” Thai femininity and Theravada Buddhist rituals and beliefs. Foreign patients in Thai hospital settings engage not only with medical practices but also with their perceptions of Thai cultural traditions—which inflect their feminine identifications. I draw on two patients' accounts of creating personal rituals to mark their gender reassignment surgery, placing these accounts within the context of biomedical globalization and debates about the touristic appropriation of non-“Western” cultural practices.

Minimizing risk in aesthetic surgery

Aesthetic or cosmetic surgery is now an international market. The USA has led the field in aesthetic surgery for decades but it has also led the way in the medicolegal market. The market in the USA is unregulated and patients are prepared to travel long distances to see the ‘the best’ or to get ‘value for money’. Various recommendations are made to reduce risk. Comparisons are made, and risks of surgical tourism highlighted.

Surgical Tourism: Some US Patients Travel Abroad for Less Costly Surgery

a large randomized trial might be able to achieve, she said. However, she said, an observational study might be preferable to a randomized trial under certain circumstances: when patients are too ill to be randomized, when no acceptable alternate therapy exists, when patients or their families decline to participate in a randomized trial, or when a disorder is so rare that it affects too few individuals to randomize. In such cases, an observational investigation might not produce the best data, she said, “but it gives you larger numbers of patients, so you don’t base decisions on 1 or 2 patients.” Sedrakyan suggested that a good combination of observational and randomized trials is essential. “We need to do a really good job of identifying those questions in surgery that are pragmatically good candidates for clinical study using randomized trials and those that are good candidates for observational investigations,” he said.

Surgical tourism and the globalisation of healthcare

In an era of globalisation, a growing number of patients are seeking surgical treatment abroad. The term surgical tourism was coined to describe the practice of travelling outside one’s principal country of residence for a surgical procedure and the associated burgeoning industry. The estimated worth of this industry was $60 billion in 2006, and is projected to be worth 100 billion in 2012 [1]. The primary driving forces in surgical tourism are the cost of surgical treatment and the length of waiting lists in the principal country of residence, and increasingly the ease with which prospective patients can access information regarding surgical tourism destinations coupled with affordable international travel. However, issues such as lack of regulation and continuity of care continue to raise concerns in the surgical tourism industry. In America, where 46.6 million residents are uninsured, savings of up to 90% can be achieved by having surgery performed in a foreign country [2]. Although in Ireland the cost of surgical procedures is far less than that of the US, it is still significantly greater than that of marketed surgical tourism destinations such as India, Thailand and Singapore. Uninsured or underinsured patients are motivated to seek the most keenly priced facility, and the potential savings from travelling abroad ultimately influence their decision. Waiting lists are a feature of most public healthcare systems and a source of considerable dissatisfaction with patients on those lists. In 2002, to address the Irish public patient in-patient waiting lists, the national treatment purchase fund (NTPF) was introduced. The key goals of the NTPF, as described in the 2007 annual report, are to deliver quality of care at the best market prices. In 2007 a revenue budget of 91.744 million, equating to approximately 0.5% of government health expenditure, facilitated the in-patient treatment of 22,069 patients. Of this number, less than 1% of the treated patients had their surgeries carried out abroad [3]. The NTPF and similar arrangements in other jurisdictions have a mandate to treat as many patients as quickly as possible within the limits of available funding. As pressure on health expenditure in the current economic climate increases can we expect the percentage of patients sent away to ‘cheaper’ destinations to increase? Furthermore, cross-border care within the EU is regulated using the basic principles of European and international law. In 1998 the European Court of Justice ruled on two key cases, that of Decker and Kohll, which introduced a new dimension in European health policy making [4]. In the case of Mr. Decker the court ruled that his health insurance providers’ refusal to reimburse him for the cost of a pair of spectacles outside his principal country of residence was against the EC treaty freedom of movement of goods [5]. In the case of Mr. Kohll the court upheld the right to obtain and be reimbursed for dental treatment in another EU country without prior authorisation. Therefore healthcare was deemed as tradeable, and available to all EU citizens regardless of their country of residence. Since the European Court of Justice (ECJ) has accepted that healthcare should be considered as a service in terms of the EC treaty, rights to healthcare have become inextricably linked with the free movement principles and are no longer restricted to the jurisdiction of the country of origin. More recently the European Court of Justice ruled in the cases of GeraetsSmits and Peerbooms from the Netherlands and determined that authorisation for treatment abroad that is deemed ‘‘normal’’ by international medical science cannot be refused if medical treatment cannot be obtained without C. Healy (&) Department of Plastic Surgery, Cork University Hospital, Wilton, Cork, Ireland e-mail: claraghhealy@rcsi.ie