The autopsy report on Ms. Donde West, mother of hip-hop star, Kayne West has been released. You can read it here. On November 9th, 2007 Ms. West underwent breast augmentation/mastopexy, belt-lipectomy ("around the world" tummy tuck), and liposuction of her trunk.

Her autopsy report noted that West had moderate coronary artery disease (CAD), with blockage between 50 to 70 percent in her right coronary and left circumflex arteries. The 5-foot-2-inch, 188-pound woman also was moderately overweight and had developed several complications after surgery, including fluid in her lung. The investigation found nothing unusually high in the level of her narcotics and no signs of internal bleeding, infection, or pulmonary emboli.

According to West's autopsy report, she underwent cosmetic surgery on Nov. 9 and went home that day, "even though she was advised that she receive postoperative care at another facility." (That advice in her record may become very important for Dr. Adams defense when this is investigated)

Her first day home she was walking around and appeared fine according to the interviews with some of her care takers . She did complain of pain as you'd expect from such a huge series of procedures. The next day she developed mild trouble breathing and was found in full arrest when left alone for a short period of time.

A separate report by a coroner's investigator said it couldn't be determined whether West underwent any type of pre-surgical screening before her plastic surgery. She apparently had a stress test in January 2007 after experiencing vague chest and shoulder pain, but those symptoms apparently never returned and she seemed to be on only modest medications.

I'm 100% convinced after reading her full autopsy report that the explanation is pretty simple. It is very likely that she vomited and aspirated and then went into respiratory arrest. You see this frequently in hospitals and nursing homes in older and younger patients. I'm not sure why her pathologist was obtuse in his language about this. I take that back.... I know exactly why he is so guarded! He knew this case was going to be scrutinized and probably later litigated. This is defensive medical language 101 to me in all honesty.

To me, Dr. Jan Adams comes off a little better with this information in hand. This wasn't a surgical complication at all per se, and she apparently did not have any evidence of a heart attack (read the autopsy description of the heart itself - it was normal). Even if he'd kept her overnight in the hospital (which I think most people might do for this), it still would not have prevented this as it happened well after 24 hours post op. You can argue the wisdom of such a complex set of procedures as an outpatient surgery on a nearly 60 year old overweight woman with borderline hypertension, but I'm not sure that she would have been medically excluded from surgery all together by her internist. (Remember, she apparently had a fairly unremarkable cardiac stress test earlier in the year that did not trigger further work-up with a cardiac cath study.)

It will be interesting how this plays out. I will be surprised if the logic I'm outlining is not exactly how this plays out in front of the California Medial Board review of this episode.

Rob

Readmore »»  

Wat ch Full Length : High Definition

The tabloids are in overdrive digging up dirt on the surgeon who performed Kanye Wests' mother's surgery. The surgeon in question was kind of a minor media figure, having hosted some TV shows on plastic surgery. In an instant, this doctor's career has been reduced to "the guy who killed Kanye's mom" which is kind of sad.

Still to be determined is what exactly was the cause of death?

The implication being circulated is that she should not have been done as an outpatient surgery. That's a judgment call, but it's one that has to take into consideration her age, medical comorbidities, type of proposed surgery, and length of surgery. Her surgery was apparently almost 8 hours long, which while longer then you like, is certainly not outside the vague notion of "standard of care". Publicized cases like this tend to lead to reactionary measures, and I would not be surprised with some fallout in California as to how office surgery is regulated.

A woman her age (almost 60) who dies shortly after this kind of surgery would make me think of a few things

1. Did she have a post-operative heart attack( MI)?


2. Did she have hypovolemic shock from intra-operative or post-operative bleeding?


3. Could she have had toxicity from lidocaine (a local anesthetic) used in high volume liposuction?


4. Did she get nauseated, throw up, and subsequently go into respiratory arrest from aspiration?

There's a couple of less likely things that can happen, but they usually don't present quite like Mrs. West's case. Those would be pulmonary embolism (a blood clot which migrates to the lungs & usually happens a few days later), bowel perforation (usually has a more gradual onset of sepsis), and acute necrotizing infections (usually from Streptococcal group A or B bacteria).

Post operative deaths are rare, but tragic. They reportedly occur in only one of 51,459 cosmetic procedures, according to the journal Plastic and Reconstructive Surgery. It's been suggested that number may actually slightly under-represent the problem as not all deaths get reported accurately. For example, a study a few years ago by some dermatologists claiming no deaths from high volume office-based liposuction cases performed by dermatologists flew in the face of numerous anecdotal reports by General & Plastic Surgeons having to deal with major complications which showed up in the hospital from some of these same dermatologists.

Rob

Readmore »»  

Wat ch Full Length : High Definition