A Survey of the Current Status of Anesthesiology for Plastic and Cosmetic Surgery in China

  Objective  To investigate the current status of anesthesiology in plastic and cosmetic surgery in China, so as to provide a basis for standardizing the regulation of this industry and ensuring the safety of patients during perioperative anesthesia.

  Methods  From November 1, 2021 to January 31, 2022, the online questionnaires were used to investigate the anesthesia practice status of medical institutions providing anesthesia services for plastic and cosmetic surgery in China. The contents of the questionnaires included the setting of anesthesiology department, the general information of the chiefs of the anesthesiology department, the anesthesia staffing of plastic and cosmetic surgery, the configuration of anesthesia-related equipment and emergency medicine, the responsibilities, status of training and scientific research of the anesthesiologists sub-specializing in plastic surgery, and the adverse events of anesthesia in plastic and cosmetic surgery. Then, the survey results of public and non-public medical institutions were compared.

  Results  A total of 244 medical institutions were investigated, including 118 public hospitals and 126 non-public medical institutions. (1)The setting of the anesthesiology department: 100% of public hospitals and 98.41% of non-public medical institutions have established anesthesiology departments. Among them, the proportion of anesthesiology departments in non-public medical institutions that were affiliated to plastic surgery was significantly higher than that in public hospitals (32.54% vs. 17.80%, P=0.008). (2)The general information of the chiefs of the anesthesiology department: compared with non-public medical institutions, the proportion of senior title (94.07% vs. 64.29%, P < 0.001), graduate degree (61.02% vs. 26.19%, P < 0.001), and the duration of anesthesia service more than 15 years (86.44% vs. 38.10%, P < 0.001) of the department chiefs or designated persons in public hospitals were higher. (3)The anesthesia staffing for plastic and cosmetic surgery: 15.87% of non-public medical institutions didn't have full-time anesthesiologists for plastic surgery; 34.92% of non-public medical institutions employed part-time anesthesiologists to provide anesthesia services. The number of anesthesiologists in each operating room for plastic and cosmetic surgery in public hospitals was obviously higher than that in non-public medical institutions (1.35±0.15 vs. 0.85±0.10, P=0.004). However, the average ratio of operating rooms to anesthesiologists was less than 1∶1.5 in both types of institutions. In terms of the ranking of anesthesiologists, public hospitals had more chief physicians (11.14% vs. 6.50%, P=0.009) and residents (28.77% vs. 20.42%, P=0.020) than non-public medical institutions. In addition, the proportion of anesthesiologists sub-specializing in plastic surgery that have doctoral degree (13.81% vs. 2.36%, P < 0.001) and master degree (45.03% vs. 21.51%, P < 0.001) in public hospitals was higher than that in non-public medical institutions. (4)The configuration of anesthesia-related equipment and emergency medicine: the allocation rate of anesthesia recovery room (92.37% vs. 73.02%, P < 0.001) and other anesthesia-related equipment in public hospitals was higher. (5)The responsibilities, training and scientific research of anesthesiologists sub-specializing in plastic surgery: the ratio of plastic and cosmetic surgeries requiring anesthesia services in non-public hospitals was less than 50% in the past three years, while public hospitals accounted for more than 50%. Both public hospitals and non-public medical institutions adopted general anesthesia (51.57%, 59.93%), and intravenous sedation (35.71%, 36.14%) as the main anesthesia methods for plastic and cosmetic surgery. The proportion of anesthesiologists performed multiple cases of anesthesia simultaneously (12.71% vs. 31.75%, P < 0.001) and working hours > 50 hours per week (10.17% vs. 26.19%, P=0.017) in public hospitals were lower than those in non-public medical institutions. In public hospitals, the percentage of anesthesiologists engaged in plastic and cosmetic surgery who participated in national continuing education training (51.80% vs. 38.10%, P=0.033) and the per capita number of Chinese core journal papers (0.66±0.14 vs. 0.36±0.12, P=0.001) and SCI papers (0.21±0.06 vs. 0.07±0.03, P < 0.001) were more than those in non-public medical institutions. (6) The adverse events of anesthesia in plastic and cosmetic surgery: The incidence of anesthesia-related complications in plastic and cosmetic surgery in public hospitals in the past three years was lower than that in non-public medical institutions(P < 0.001), and both showed a downward trend year by year.

  Conclusions  The lack of anesthesiologists in medical institutions that provided anesthesia for plastic and cosmetic surgery was obvious, especially in non-public medical institutions. Compared with non-public medical institutions, public hospitals have obvious advantages in the discipline construction of anesthesia, the configuration of anesthesia-related facilities and equipment, professional and technical level, educational background, professional training, and scientific research capabilities, which lead to the reduction of incidence of anesthesia-related complications in plastic and cosmetic surgery.