By Elizabeth Ziemba, JD, MPH, President, Medical Tourism Training
Director, Project Red Solutions
A recent new story about the death of a Saudi citizen in Türkiye following complications from leg lengthening surgery set off my alarm bells as well as piquing my curiosity about this procedure. What is leg lengthening surgery? It sounds complex and a bit terrifying. If the surgical procedure is as complex as it sounds, how is the post-discharge process managed for medical tourists? Did poor discharge planning contribute to the patient’s death? Here is what I found out about this emerging trend.
Increasing Demand
Demand for limb lengthening, particularly leg lengthening, is increasing among men.
Recent accurate statistics are hard to find. “As of 2020, centers in the US, Germany, and South Korea carried out the procedure between 100 and 200 times a year, while Turkey, India, Spain, and Italy performed between 20 and 40 a year.” In light of these small numbers, leg lengthening surgery is not a common procedure.
This reported increase is being driven by improvements in surgical techniques. In the past, common limb lengthening surgeries were medically necessary to correct deformities, adjust limb length when one is shorter than the other, and reconstructive surgery. Now, thanks in part to improved surgical techniques, leg lengthening is an elective surgery to make men taller.
Economic and Social Factors
Economic and social stigmas related to men of short stature are driving men to endure this painful and expensive procedure.
Research seems to correlate height to economic success. A 2004 study found the economic benefits to being a tall man. “A 6-foot person was predicted to earn $166,000 more than a 5'5" person over a 30-year career”.
Short jokes abound in society.
Social media compounds this stigma especially in the world of dating and dating apps. Height jokes abound in politics. During this year’s US Presidential campaign, Donald Trump poked fun at his opponent, Ron DeSantis, joking about his height and the alleged use of lifts in his boots. The UK’s Prime Minister, Rishi Sunak, one of the country’s shortest, uses his stature to his advantage, saying, "I've been meeting so many people who've said 'wow, you're even shorter in real life'."
Social pressures and actual or perceived discrimination based on height can lead to a medical diagnosis. The diagnosis of height dysphoria or height neurosis is a term that refers to a body image anxiety disorder where patients are unhappy and distressed because they are short or perceive themselves as short.
With improved surgical techniques as well as sophisticated advertising directed at men, more men are electing to undergo this surgery.
About the Surgery
Doctors perform leg lengthening by surgically breaking the bones of either the upper or lower leg, and then inserting a telescopic rod or "nail". That device expands inside the bone with the help of an external remote control.
The expansion process takes about 3 months on average until the gaps in the bones fill in. The rods are surgically removed within one year, requiring another surgery and recovery time.
As might be imagined, there are numerous potential complications from this procedure. If the US hospital readmission rate of 37% for this surgery is a global benchmark, the risk of complications leading to readmission are more than double the overall US readmission rate. This article has an accurate description of the surgery and healing process if you would like more in-depth information.
In other words, the surgery is complex, delivered over the period of one year, requires a second surgery, and carries a substantial risk of complications that can lead to hospital readmission or death. With numerous transitions of care spread over the course of one year, an accurate and complete discharge planning process with consistent patient follow up is essential to reducing the risk of complications including hospital readmissions or death. The discharge planning process is even more complicated for international patients when logistics plus communication among various healthcare professionals is factored into the equation.
Leg Lengthening and Medical Tourism: Price and Availability
Service providers in medical tourism destinations know that availability of treatments at lower prices than in the home country are two of the major decision-making drivers for individuals looking for treatment abroad. These levers are being pulled to attract men who would like to be taller.
The price in the United States for the initial surgical itself is between $75,000.00 - $200,000.00. Elective surgeries are not covered by insurance, so payment is made out of pocket. Additional costs include an extensive period of recovery requiring physical therapy, use of medical devices, medications, and other related expenses. Plus, there is the cost of the second surgery to remove the rod and the additional costs associated with that surgery.
While there are qualified surgeons around the world who can perform limb lengthening surgeries, the search for choice involves overcoming the barriers of no insurance coverage for elective surgery and the high price of the procedure in the US as well as other countries including Germany and the United Kingdom. Paying out of pocket is not possible for most people.
In response, medical tourism destinations like Türkiye and Mexico are offering “cheap” prices to attract international patients for a wide variety of treatments including limb lengthening.
A Google search of “leg lengthening” + “medical tourism” brings up a list of clinics in Türkiye describing “limb lengthening as a common procedure” (this website is blocked by my Malware software). Another site states, “Limb lengthening surgery Turkey is a popular procedure due to the high-quality medical facilities, experienced surgeons, and relatively low cost of limb lengthening surgery in Turkey compared to other countries” with prices starting at €25,000.
The Google listings go on with similar statements and pricing. Sites in Mexico and Iran, among others, make similar promises of cheap prices, experienced surgeons, and beautiful beaches. Describing limb lengthening as a “common procedure” in Turkey clearly downplays the true nature of surgeries being performed annually compared to hair transplants in Türkiye. The marketing language may provide a false sense of security about the complexity of the surgery itself and the risk of complications.
Ethical considerations aside, it is clear from the complexity of the surgery itself, extended period of treatment and recovery, use of medications for pain management, delivery of services across different healthcare providers, that patients undergoing limb lengthening require careful and complicated post-discharge planning and management especially for international patients.
While the Saudi government conducts its investigation into the causes of this person’s death, it is not clear as to what caused his demise. Apparently, the surgery itself was successful but during his physical therapy recovery, his condition worsened, and he died. At this time, it is impossible to know if his discharge plan was flawed, if his treatment was substandard, or if there were other contributing factors. Time will tell.
Discharge planning for all patients and managing their transitions of care need to be managed thoughtfully with extra care given to logistics as well as clinical care. Project RED (Re-Engineered Discharge) provides a clear set of planning guidelines supported by 15 years of peer-reviewed, data driven research to create comprehensive discharge plans to improve clinical outcomes, increase patient engagement, and reduce hospital readmissions. Our team at Project Red Solutions is ready to collaborate with you to deliver these financial, clinical, and patient-centered benefits. Contact us today.
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