Abdomionplasty Done by Military Provider Inmilitary Hospital?

Approved by Tricare. Patient has had 3 csections prior and is overall healthy. As any person would wish to know are morbidity rates higher for this situation ? Pulmonary embolisms or DVT a higher risk when done by a military surgeon in a military hospital?

Doctor Answers 5

Not sure whether complication rates are higher in a military hospital

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Surgical outcomes or primarily related to the surgeon. I don't know whether complication rates in general or higher in military hospitals than others.

Military surgeon and facility?

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

As with civilian surgeons, the risks in terms of physician capability all are primarily determined by the individual surgeon's training and experience. When I trained at the Mayo Clinic, both of my fellow chief residents were military and as soon as our residency was over they both went to do their duty at military hospitals and both were excellent. Also, some of the worst plastic surgeons in the world live in Beverly Hills and are at private hospitals and offices as evidenced by what is seen in some high profile celebrities who have to wear their complications publicly. Good and bad surgeons are found everywhere. I would not let the military issue affect your decision but I would check training credentials, board certification, and experience. 

Grady B. Core, MD
Birmingham Plastic Surgeon
4.6 out of 5 stars 13 reviews

Selecting a plastic surgeon

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

I would go about selecting  a plastic surgeon for an abdominoplasty as I would with any other cosmetic plastic surgical procedure.  Do your homework, research the operation and select a physician that you feel comfortable with.  As with any surgery there is no substitute for skill, compassion, understanding and experience.  If the plastic surgeon in the military meets these qualifications then I would feel he would be able to perform this operation.  The risk for DVT or PE should be no greater with any experienced plastic surgeon who selects his patients well and takes all necessary precautions. 

Jeffrey Zwiren, MD
Atlanta Plastic Surgeon
4.5 out of 5 stars 20 reviews

Abdominoplasty Done by Military Provider In military Hospital?

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

 I know a number of surgeon colleagues who practiced in military hospitals, and they have had nothing but good things to say about their experiences, both as physician and occasionally as patient. 

It is most unlikely that there is comparison data of DVT and PE rates for military vs. civilian hospitals. Even if there were, the populations are so different that the comparison data would be questionable. 

One thing you can do on your own is to check the "Caprini score" which is a risk management tool for prevention of clotting. You can google the check list, add up your score, and if it is 5 or greater most surgeons would recommend a week of anticoagulation with Lovenox. 

It is hard to imagine a surgeon in a major hospital not doing the other preventions, such as bending the knees and using SCD's (sequential pressure devices) to compress the calves during surgery. 

As I would recommend for any surgeon, check for board certification, look at patient photos. 

All the best. Thanks for your service. 

Jourdan Gottlieb, MD
Seattle Plastic Surgeon

Is risk higher with military surgeons or Tricare providers?

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Having been both an active duty physician in the US Navy Medical Corps as well as a civilian contractor providing plastic surgery services at US Naval Hospital San Diego and sitting on the Quality Assurance Board for the Tricare regional provider, I feel somewhat qualified in answering this question.  I don't think that the issue is whether the provider is a military surgeon or the hospital is a military hospital, per se, rather it has more to do with the training and experience of the surgeon himself or herself and the experience of the hospital personnel in dealing with this type of surgery.  I can tell you that on the whole, some of the best surgeons that I have worked with have been military surgeons, and in general, at least at the major military referral centers, the facilities and the staff are excellent.  The problem is that military medical personnel don't always get to see elective aesthetic surgical procedures because their mission is different for the most part.  While cosmetic surgery is part of the heritage and training of all plastic surgeons, the military medical system, including plastic surgeons, has as its primary mission the care of those serving on active duty.  Elective cosmetic procedures sometimes take a secondary position.  Therefore, the "reflexes" of a military plastic surgeon when it comes to cosmetic surgery might not be the same as a surgeon who does that kind of surgery all the time, or a staff that takes care of this kind of patient all the time.  I have always believed in the importance of cosmetic surgery for military surgeons, because cosmetic surgery believe it or not, makes reconstructive surgeons better.  It is the one time that we as surgeons get to take a patient to the operating room electively with essentially normal anatomy for the purpose of improving that normal anatomy and its form, and the ability to do that goes hand in hand with the ability to repair the disfiguring injuries seen in the military population at war.  Risks such as that of DVT and PE are almost numerically calculable, and they can be managed and reduced by any surgeon, but if the surgeon isn't aware of the state of the art or the facility and staff aren't prepared for that risk in that type of patient, the risk may be higher.  But this isn't necessarily an issue of being military.  It's an issue of experience and knowledge in general, and you will find inexperience throughout the medical community - civilian and military.  My best advice to you is the same advice that I would give anyone contemplating this surgery anywhere.  Do your due diligence when it comes to selecting your surgeon.  Don't go with the "lowest bidder" just to save money.  Make sure that the surgeon can demonstrate adequate experience in this type of procedure to your satisfaction.  View pre- and postoperative pictures, ask to speak to other patients who have had similar procedures by that surgeon, ask the difficult questions about board certification, experience, complication rates, and the like.  It is sometimes a bit more difficult to research malpractice claims on military surgeons because the military system is different that way from the civilian system, but educate yourself on the differences and find out how you can research for disciplinary actions against that surgeon.  Make sure you are satisfied that the surgeon believes that the postoperative care plan and facility are satisfactory for your care.  And get a couple of other opinions, perhaps outside of the military hospital, just for perspective and to educate yourself.  If you have any reservations about any of that, it is best not to go to that surgeon, regardless of Tricare approval, because you can't save enough money that way to make up for a bad experience or a complication.  On the other hand, if you find that the surgeon is caring, has good track record with good experience and is knowledgeable in the area, has happy patients and good results, then I would have no reservation going to him or her, because, again, some of the finest people I know serve our country in uniform, and many of them are doctors, nurses, and corpsmen.  I hope that helps, good luck.

Joseph L. Grzeskiewicz, MD
San Diego Plastic Surgeon

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.