The NHS teams mopping up sloppy foreign surgery

Telegraph

3 days ago

As consultant plastic surgeon at Manchester's busy Wythenshawe Hospital, a typical day for Dr Fouzia Choukairi involves spending hours in the operating theatre reconstructing someone's limbs following a terrible traffic accident.
But every few weeks, she or an on-call colleague will be buzzed to the A&E department where, among the melee of broken bones, bleeding gashes and limping children, she will face a different challenge: performing sometimes life-saving treatment on a patient who has returned from overseas having had cosmetic surgery.
'They may have had tummy tucks [abdominoplasty] or breast implants,' she explains. 'But then they will have got a wound or implant infection after flying home, and they may be very, very sick. They can need life-saving treatment, and it can involve a huge team – not just the A&E staff but surgeons, microbiologists, intensive care specialists, anaesthetists, nurses, wound care and rehabilitation staff.
'The patients are often very grateful, and sometimes verbally regret having had the surgery,' she adds. 'I guess you're not going to stop people from going abroad for surgery, but we do feel patients are not well-informed or well-equipped to deal with any complications.'
For years, NHS staff have voiced concern at having to 'mop up the mess' caused by foreign cosmetic procedures mostly undertaken in Turkey, considered the medical tourism capital of the world.
All too often, they say, the promise of cheap liposuction, BBLs (Brazilian butt lifts), facelifts and hair transplants promoted online and sold as part of 'luxury holiday packages' can result instead in infections, blood clots, sepsis, deformities and even death.
Now, however, they are warning of a new issue – that of antibiotic-resistant superbugs being brought back from overseas into UK hospitals by these patients.
'Turkey is a gateway between East and West,' explains Dr Choukairi, who also works at Hale Private Clinic in Manchester. 'You have a huge mixture of people from all over the world flowing through these hospitals, airports and hotels. The patient would have travelled back on a plane, perhaps with open wounds or dressings, and they can pick up multi-resistant bugs at any of these steps.
'Usually, antibiotics can target infections very efficiently but if you're faced with a multi-resistant bug or an unusual bug, you have to throw broad-spectrum antibiotics at it, which are not as efficient and may take longer to clear it.
'If the person is very sick and requires intensive care, this is the worst-case scenario. And, of course, there is a small risk these bugs can be passed onto the person in the next bed if, say, they are immunosuppressed or also have open wounds.'
Alarming developments
Her concern over antibiotic-resistant bugs being brought into the NHS is not in isolation. At the recent Royal College of Nursing annual conference in Liverpool, NHS nurses spoke of 'horrific' wounds and infections seen in patients following overseas surgery.
Nykoma Hamilton, an infection control nurse in Fife, Scotland, said patients were increasingly infected with bacteria resistant to even the strongest antibiotics – a group of drugs called carbapenems, which are used as a last resort when all other antibiotics have proved ineffective. Describing the superbugs as the 'absolute granddaddy of resistance', she told the conference that NHS hospitals and clinics in her area had recorded a 'near 30 per cent' increase in carbapenem-resistant bacteria in recent years.
'Our concerns relate to the fact that a lot of people are colonised with a lot of extensively drug-resistant organisms,' she said.
It is an alarming development. The World Health Organisation has previously warned that the world is heading for a 'post-antibiotic' era, with figures from the UK Health Security Agency showing the number of antibiotic-resistant infections across the UK has grown by seven per cent in recent years, up from around 62,000 in 2019 to nearly 67,000 in 2023.
Doctors are also warning the risk of such infections is only likely to grow due to the numbers having foreign cosmetic surgery rising each year. Last year, an estimated 150,000 Brits travelled to Turkey for beauty tweaks – with some saying the rise of NHS weight loss drugs such as Wegovy and Mounjaro have fuelled the trend.
'Massive weight loss can result in loose skin on the face, tummy, arms and thighs,' says Dr Mo Akhavani, consultant plastic surgeon at the Royal Free Hospital in Hampstead, London, who regularly deals with post-operative complications. 'People understandably don't want to live with this, but the NHS has finite resources and, although the health benefits are well known, the procedure is deemed low priority, so people go overseas for cheap surgery.
He adds: 'The surgeons in Turkey are often very good and the vast majority of operations go right, but the aftercare can be a problem.'
Dr Akhavani, who also works at London's Plastic Surgery Group, says he has helped a 'growing' number of patients, especially since Covid. In 2023, figures from the British Association of Aesthetic Plastic Surgeons (BAAPS) also showed a 94 per cent rise in three years of people needing corrective surgery on the NHS – with the total cost to the taxpayer being around £4.8 million.
'There are factors leading to this increased risk,' he tells The Telegraph. 'First, if a patient has had huge weight loss, they may well have had other conditions such as diabetes and high blood pressure, which can cause complications.
'Then they may have multi-site surgery, which UK doctors wouldn't advise doing, where loose or fat skin is removed from several areas, and perhaps combined with breast implants or other procedures, meaning longer on the operating table and an increased risk of blood clots and even death.
'Thirdly, patients must also refrain from getting on a flight for six weeks post-surgery but they often fly straight home, which can lead to wound-healing problems.'
Dr Akhavani adds, 'We see them in A&E sometimes with gaping wounds and pus pouring out. They need antibiotic drips, then can be taken into theatre to wash out the infection, and may end up in intensive care for weeks. Often we are giving life-saving treatment but we will not correct deformities, such as removed implants, from the emergency surgery. This is the NHS and that ultimately means taxpayers' money needs to be protected.'
In previous years, both the BAAPS and the British Medical Association (BMA) have highlighted the risks involved with the $4.5 billion (£3.5 billion) global industry. These include the lack of proper consultations and risk assessments, paperwork in a foreign language, and a financial commitment to the surgery prior to travel.
Aftercare concerns
With surgery tied to luxury packages, patients may often have top hotels and transport, but no health monitoring post-surgery. One doctor told The Telegraph in graphic detail of a patient who had had a BBL, but then flew home, with the fat seeping out of the wound while on the plane. The patient needed three separate surgeries to repair it and was left 'traumatised'.
A second nurse at the recent RCN conference recounted a young woman who had skin removal in Turkey, then returned to the UK with a large thigh wound only loosely held together with stitches. She also had dying tissue and sepsis.
'All she told me about was how fantastic the hotel was after she'd had her surgery and that they took her back to a posh car,' she said. 'But there was no blood pressure testing, no aftercare for this woman at all. In fact, I'm surprised she made it back on the flight. It's really scary.'
In 2022, a mother from Berkshire, known only as Carrie, contracted a flesh-eating virus after having a £4,500 tummy tuck in Istanbul. Four days after returning to the UK, she was rushed to hospital and treated for sepsis and organ failure. The same year, Pinky Jolley required treatment in two Liverpool hospitals following botched £2,100 gastric sleeve surgery abroad that left her with multiple infections, sepsis and a permanently damaged oesophagus and stomach. She was left needing a feeding tube and largely bed bound.
The growing probability of superbugs has also been highlighted, with the BAAPS saying: 'Some people are returning with multi-resistant bacteria that are hard to treat and may infect other people.'
In November 2024, following a spate of deaths of women who had flown to Turkey for BBLs, these concerns reached the top of government, with Wes Streeting, the Health Secretary, urging people to 'think very carefully' before going overseas for surgery. Back on the NHS front line, however, doctors see little chance of this happening.
Dr Amer Hussain is a plastic surgeon at Leeds Teaching Hospitals. His work involves reconstructing breasts for women who have had mastectomies following cancer. But at times he has to postpone such operations due to hospital bed shortages caused by beds occupied by those in need of urgent care.
'Patients come in following Turkey operations with infected breast implants,' he says. 'They have redness, fever or discharge from the wound and the implant needs to be removed. We are also seeing bad infections – with the bugs not even necessarily endemic to Turkey, meaning they are coming from elsewhere in the world.'
Like all doctors, he is aware of the strain on the NHS. 'I do major breast reconstruction, often for cancer patients, and the backlog of these operations due to Covid has still not been reduced,' he explains. 'So doing these emergency surgeries does have an impact on waiting times, beds and theatre time.
'The problem is that this is high-volume surgery abroad, without checks and balances, and the NHS is being forced to step in. But it is frustrating, because at the end of the day, where resources are precious, they should be for patients who need them the most.'