Study Reports High Frequency of Emergency Complications During Dermatological, Surgical, and Cosmetic Procedures

Fifty-three percent of dermatologists report having faced emergency complications during dermatological or surgical procedures, according to a recent study published in the Journal of Cosmetic Dermatology.¹

Furthermore, 43.2% reported experience with emergencies during cosmetic procedures. Researchers noted that while such complications may not be extremely common in nature, clinicians should be prepared for interventions when necessary.

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Background and Methods

A previous review published in the British Journal of Dermatology² assessed the frequency of complications and their nature. Out of 3,788 surgical procedures reviewed, complications occurred in 6% of procedures, with the most common issues reported as bleeding and vasovagal syncope.

Researchers of the present study, Erdogan et al, noted that health care providers, including dermatologists, may not feel confident enough in their ability to adequately subdue emergency scenarios. This prompted their study with a goal of determining the frequency and nature of medical emergencies while simultaneously assessing dermatologists' knowledge and skills of such scenarios.

The study, conducted between December 2022 and January 2023, involved a web-based, 33-item questionnaire distributed to dermatologists via email and social media. The survey collected sociodemographic and professional data, details on dermatological, surgical, and cosmetic procedures performed, and experiences with emergency complications such as vasovagal syncope, seizure, anaphylaxis, hyperventilation syndrome, hypotension/bleeding, and cardiac arrest. Dermatologists were also asked to share their knowledge of basic life support and management of emergencies.

Findings

The study involved a total of 240 dermatologists, primarily female (81%), with an average age of 40 years. Results demonstrated that 53% of dermatologists reported previous experience with emergency complications, with vasovagal syncope (58%), hypotension/bleeding (28%), and seizures (10%) being the most common. These complications more frequently occurred during biopsies and intralesional injections, particularly in the head and neck region.

Specific to cosmetic procedures, 43.2% of dermatologists reported having encountered emergencies, with dermal filler and botulinum toxin injections being the most common procedures at the time of an emergency scenario.

Regarding their overall sense of preparedness, 27% of dermatologists reported having no prior basic life support training, while 31% reported having exclusively theoretical training, and 42% reported having comprehensive training—or a combination of both theoretical and practical training.

The study also examined occupation, level of education, and level of experience. It included specialists (54%), residents (23%), assistant professors (9%), associate professors (7%), and professors (7%), with experiences with emergency complications being more prevalent among specialists, those with over 15 years of experience, and those performing 10 to 50 dermatological and surgical procedures on a weekly basis. Individuals working in private clinic settings and who reported performing fewer than 10 cosmetic surgeries each week also had a higher rate of emergency experience.

When asked about their knowledge of managing emergency complications, nearly half of the participants (47%) rated their skills as fair, with only 21% considering themselves "good" or "very good." Knowledge scores were highest among residents (8.13 ± 2.11), dermatologists with 0 to 4 years of experience (7.95 ± 2.21), those currently working in university hospitals (7.73 ± 2.21), and those with previous comprehensive basic life support training (7.10 ± 2.54).

Ninety-five percent of dermatologists expressed interest in further training on emergency complications and basic life support.

Conclusions

"To the best of our knowledge, this is the first study evaluating the frequency of dermatologists who experienced emergency complications during dermatological, surgical, or cosmetic procedures and evaluating their level of knowledge on basic life support," according to Erdogan et al.

Potential limitations of the study, however, include its cross-sectional design, the nature of the survey having been conducted online, the study's reliance on memory-based data, and the use of self-reported data related to complication frequency.

While researchers noted that dermatological procedure complications may not be common in nature, dermatologists should be competent and well-trained for emergency scenarios.

Moving forward, they suggested that dermatologists be provided with comprehensive theoretical and practical training programs on a regular basis that provide education and refresh clinicians on emergency and basic life support scenarios.

References

1. Erdogan HK, Tekin MS, Agaoglu E, et al. Emergency complications during dermatological, surgical, or cosmetic procedures: a cross-sectional study among dermatologists. J Cosmet Dermatol. July 20, 2024. https://doi.org/10.1111/jocd.16479
2. Amici JM, Rogues AM, Lasheras A, et al. A prospective study of the incidence of complications associated with dermatological surgery. Br J Dermatol. 2005;153(5):967-971. doi:10.1111/j.1365-2133.2005.06861.x