Public healthcare costs of complications of cosmetic surgery in Sweden – a regional study

BACKGROUND: Cosmetic surgery has increased during recent decades, both domestically and through cosmetic tourism. Patients who develop postoperative complications frequently seek care in the public healthcare system. The extent to which these complications generate healthcare workload and costs within Swedish public hospitals remains poorly described. METHODS: This retrospective cohort study includes patients presenting with acute complications after cosmetic surgery to the three hospitals in Region Örebro County, Sweden, between 2018 and 2024. Patients were identified through medical records and administrative systems. Cosmetic procedures performed locally, elsewhere in Sweden, or abroad were included. The primary outcome was direct hospital cost per patient estimated using diagnosis-related group weights. Secondary outcomes included emergency department attendance, hospital admission, length of stay (LOS), diagnostic investigations, surgical interventions and outpatient follow-up. Statistical comparisons between groups were performed using chi-square tests, independent sample t-tests and non-parametric tests where appropriate. RESULTS: A total of 53 patients were included. The majority were female (88.7%) with a mean age of 42.1 years. The most common procedures associated with complications were abdominoplasty, breast augmentation and reduction mammoplasty. Infection with or without abscess was the most frequent complication. Patients operated in Sweden had a higher rate of hospital admission compared with patients operated abroad (48.0% vs 13.6%, p = 0.01), while LOS was similar between groups. In contrast, patients operated abroad required more outpatient physician follow-up. The mean estimated healthcare cost per patient was 45,956 SEK, Swedish crowns (€3890). Patients operated in Sweden generated higher average costs compared with patients operated abroad (58,460 SEK vs 28,688 SEK). The total estimated cost for managing complications in the cohort was approximately 2.3 million SEK. CONCLUSIONS: Complications after cosmetic surgery generate a measurable workload and cost for the public healthcare system. In this regional Swedish cohort, a substantial proportion of complications originated from procedures performed domestically rather than abroad. These findings challenge the perception that the public healthcare burden from cosmetic surgery complications is primarily driven by cosmetic tourism. Improved coordination between private cosmetic providers and the public healthcare system may help reduce the clinical and economic impact of these complications.