A review of a decade of data highlights infection risks, including nontuberculous mycobacteria, among patients seeking surgery abroad and across state lines.
US residents traveling for cosmetic procedures face significant risks for postsurgical infections and other adverse outcomes, according to a report from the Centers for Disease Control and Prevention (CDC).
The review, which analyzed CDC consultations from Jan 1, 2014, to Dec 31, 2024, identified 21 investigations involving approximately 145 patients who traveled for cosmetic care. While 17 of these consultations involved international travel, four involved domestic travel within the US. The most common procedures associated with these adverse events were liposuction and abdominoplasty.
Infection Risks and Pathogens
Postsurgical infections were documented in 20 of the 21 consultations reviewed. Notably, 12 of these cases identified suspected or confirmed nontuberculous mycobacteria (NTM). According to the report, NTM accounted for all domestic consultations and the majority of international cases.
The invasive nature of cosmetic surgery, combined with potential exposure to nonsterile ice and water, may contribute to the high proportion of NTM infections, according to the report. These pathogens are often associated with breaches in healthcare infection prevention and control (IPC) standards.
“Persistent IPC gaps contribute to a higher risk for infection, and addressing those gaps should be prioritized to ensure safety of cosmetic procedures,” the report states.
Lapses in Infection Control
The CDC identified several specific failures in healthcare settings, which most frequently included surgery centers or clinics. IPC findings from available investigations highlighted gaps in:
- Environmental cleaning practices,
- Use of personal protective equipment,
- Hand hygiene, and
- Reprocessing of surgical equipment.
The report also noted that four consultations involved patient deaths. Outbreaks related to medical travel are particularly difficult to detect because they often involve patients from multiple states who are geographically separated after their procedures, making coordination between health departments essential, the CDC report states.
Clinical Recommendations and Surveillance
The study suggests that clinicians maintain a high level of suspicion for infections, particularly NTM, when treating patients who have recently traveled for surgery. Because NTM infections can be difficult to treat and are not always nationally notifiable, public health experts recommend investigating even a single case of healthcare-associated extrapulmonary NTM.
The report emphasizes that while low cost and shorter wait times are primary motivators for patients to travel, the lack of uniform regulation can lead to varying standards of care. US residents may encounter different IPC and water management practices depending on the locality or country where the procedure is performed.
To improve surveillance and early identification of adverse outcomes, the CDC requests that clinicians notify state or local health departments of complications related to medical tourism. The agency is also working with international partners, including ministries of health, to address IPC concerns and decrease future risks to patients.
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