New study highlights serious complications and NHS pressures linked to cosmetic limb lengthening abroad

Patients travelling overseas for cosmetic limb lengthening can face serious complications that place additional pressure on NHS services, according to new research published in The Annals of the Royal College of Surgeons of England. 

The study, led by specialist limb reconstruction surgeons, examined patients presenting to a specialist limb reconstruction service at the Royal National Orthopaedic Hospital following limb lengthening surgery undertaken abroad and found several had experienced serious complications requiring further treatment, rehabilitation and, in some cases, complex corrective surgery. 

Complications documented in the study included implant failure, poor bone healing, severe joint stiffness and deformity. Researchers found patients frequently required multiple hospital contacts and physiotherapy, with some needing significant surgical intervention to manage problems arising after their original procedure. 

The study also highlights the impact on NHS resources when complications from surgery abroad are treated back in the UK. The authors identified a net financial burden to the NHS of more than £36,000 across the cases reviewed, with the two patients requiring corrective surgery accounting for the largest share of costs, alongside pressure on specialist limb reconstruction services. 

The findings add to wider concerns about the impact of surgery abroad on patients and NHS services. RCS England has been calling for the NHS to collect data on patients requiring treatment for complications after undergoing surgery abroad; to better understand the scale of complications and the pressures they place on NHS services. The authors say a broader national picture is needed to understand the full extent of the issue. 

Further findings

• The study documented major complications in multiple patients following limb lengthening surgery abroad, with only one patient returning to the original provider for corrective treatment.  
• Patients had a median of 10 hospital contacts each, with all requiring physiotherapy and some needing extensive follow-up care.  
• Cost and availability were the main reasons patients chose surgery abroad.
• None of the patients had undergone pre-travel consultations, raising concerns about informed consent and patient preparation. Some patients had hidden their procedures from their families.  
• The authors say the findings point to the need for better understanding of the scale of complications from surgery undertaken abroad and their impact on the NHS. 

Mr Peter Calder, lead author and Consultant Paediatric and Limb Reconstruction Surgeon, said: 

“Limb lengthening involves complex surgical techniques, with pre- and post-operative involvement of multidisciplinary teams, to ensure optimal surgical and functional outcomes.  
 
“Anecdotally, we have seen an increase in patients presenting to our hospital following lengthening surgery abroad. All required intensive physiotherapy and, in many cases, surgical intervention for serious complications. This resulted in both an increase in burden on staff and financial costs for the NHS. It is unclear whether this is a localised problem or more widespread throughout the UK.  
 
“The findings provoke debate on health tourism and patients returning to the UK with poor outcomes, especially with reference to cosmetic procedures.” 

Commenting on the findings, Professor Frank Smith, Vice President of the Royal College of Surgeons of England (RCS England), said: 

“This study shines a light on a growing patient safety issue. People considering surgery, such as leg lengthening, may be drawn overseas by lower costs or persuasive marketing, but when things go wrong, the complications can be serious and, at worst, life changing. Patients can then return to the NHS needing complex treatment, placing pressure on already stretched services. 

“While many providers overseas offer high-quality care, this research underlines the importance of people fully understanding the risks, the standards of care they can expect, and what aftercare arrangements are in place before undergoing treatment abroad. 

“RCS England has long called for better public awareness of the risks associated with medical tourism, and we would also like to see the NHS collect robust data on patients presenting with complications after treatment abroad. That is essential to understanding the true scale of the issue and its impact on NHS services.” 

ENDS 

Notes to editors

1. Health tourism in limb reconstruction - a recognised burden on the NHS

2. The Royal College of Surgeons of England provides world-class education, assessment, and development to 30,000 surgeons, dental professionals, and members of the wider surgical and dental care teams at all stages of their careers. Our vision is to see excellent surgical care for everyone. We do this by setting professional standards, facilitating research, and championing the best outcomes for patients. 

3. For more information, please contact the press office: telephone: 020 7869 6054/6053/6060; email: pressoffice@rcseng.ac.uk; out-of-hours media enquiries: 0207 869 6056.