Ruxandra Diana SINESCU , MD, PhD [613841]

Ruxandra Diana SINESCU , MD, PhD
Andrea ANGHEL , MD, PhD
Catalina ANDREI , PhD
E-mail : [anonimizat]
„Carol Davila” Un iversity of Medicine, Bucharest
Emanuel Eduard HERT ELIU , PhD Candidate
Bogdan Vasile ILEANU , PhD
The Bucharest University of Economic Studie s

NON -CAR ACCIDENTS AND TREATMENT IN PLASTIC
SURGERY

Abstract. The purpose of this paper is to analyze the impact of socio –
demographic and latent behavioral factors on non -car accident risk, accidents
which request surgical interventions in general and plastic surgery in particular.
The contribution to risk is analized mainly using an econometric model .
Keywords : risk accidents, surgical interventions, reg ional distribution,
logit model;

JEL Classification: A12, C2 5, I19

Introduction

Plastic surgery interventions has recorded an important increase in recent
decades both in developed and in developing countries. For example, in the U.S. ,
the number of cosmetic procedures increased from only 0.4 million in 1992 to 14.6
million in 2012. There were also 1.6 million cosmetic surgical procedures, 13
million cosmetic minimally -invasive procedures, 5.6 million reconstructive
procedures in 2012 in U.S. The expenditures of these procedures also increased
from U.S. $ 927 million in 1992 to approximately $12 billion in 2007 according to
American Society of Plastic Surgeons, (2012)
Plastic surgery is limited neither to the U.S. nor to developed coun tries:
many developing countries like Brazil, South Africa, Turkey, South Korea and
Taiwan performs cosmetic and plastic procedures.
Holliday, (2012) analyses the unusual high number of plastic surgery in
South Korea for both women and men in the context of cultural influences. The
authors show that the current positions presenting cosmetic surgery as pertinent
only to female and non -western bodies misses important cultural influences. The

Ruxandra S inescu, Andrea A nghel, Catalina A ndrei, E. Hert eliu, B. I leanu
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authors also show that the ‘western body’, as it is presented in so me literature has
little in common with actual western women’s bodies, and more in common with a
globalized image that embed elements from many different cultures.
In Fraser, (2003) the author stresses the idea that cosmetic surgery has a
rich expression i n the media and its impact on culture needs to be understood. This
recognition inspires the two main questions examined in this book. The impact of
cosmetic surgery, through its representation as much as through medical practices
is also analyzed in this w ork. The most obvious gender observation made by the
author regards the pronounced asymmetry in cosmetic surgery practice: the great
majority of surgeons are male and the great majority of participants female.
Elliot, (2008) analyses the research conducted in Europe, America and
Australasia regarding the cosmetic and plastic surgery showing the recent
development in this field.
Pearl, (2003) investigates the most desired procedures in plastic and
cosmetic surgery and found out that they were liposuction, rh inoplasty, and breast
augmentation. The most widespread source of information about plastic surgery
among the patients was teen magazines and television.
In Neligan, (2013) we can found an investigation about the p sychological
aspects of plastic surgery, m edico -legal issues in plastic surgery , and patient safety
in plastic surgery. The authors also presents some of the most used techniques in
plastic surgery like tissue graft, tissue repair, repair, grafting, and engineering of
cartilage, repair and graftin g of peripheral nerve, techniques of microvascular
surgery, transplantation in plastic surgery.
Soohyung, (2009) analyses the benefit of plastic surgery on the labor
market and shows that this benefit is small compared to the surgery cost but with
an excep tionally large improvement, the cost can be recouped in three years.
Gusenoff, (2008) investigates the temporal and demographic factors
influencing the desire for plastic surgery showing that younger, divorced, female
patients show the strongest interest i n plastic surgery for body contouring.
The psychological outcomes of cosmetic surgical procedures is
investigated in Nicki, (2013) showing that there is a high rate of post-operative
satisfaction and significant improvements in several dimensions of body i mage and
mental health, but not self -esteem.
Rosen, (2005) show s good the results obtained for three pilot cases of new
applications for the use of the mirror in rehabilitation after hand surgery.
But plastic surgery is not a result of a person desire; plastic surgery is a
must in many cases. Its benefit is sometimes non -valuable taking account the
psychological impact of results on patient after life. Beside the breast augmentation
or replacement forced by intervention after cancer disease, a great impa ct results
after interventions needed after some home, leisure and work accidents.

Non-car Accidents and Treatment in Plastic S urgery
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Most frequent interventions after home, work or leisure dangerous
accidents are related to: neck, surgeries, back surgeries, shoulder surgeries, broken
bones, displaced fra ctures, orthopedic surgeries, hip or knee replacements, etc.
Usually these kinds of interventions need patient’s hospitalization and or
long term home -care. Effects of interventions have both psychological and
economical negative effects:
-workdays lost , hospitalization cost and in some cases years lost with
disability.
We try to analyze several factors which influence the risk of accidents in
order to prevent, as much as possible,

Methodology and study

The analysis is made on a national representativ e sample formed by 18,172
respondents during the year of 2008. The sample is a part of the EHIS research
carried out in Romania by National Institute of Romania.
The methodology of sampling, calibration is in compliance with the
methodology proposed by EUROSTAT1. Due to the degree of regional sampling
representation, the distributions of respondents follow population structure by main
socio -demographic characteristics like gender, age -group, region of residence, etc.
A part of the cases from surgica l cases are coming from different types of
accidents which can be avoided.
An overview on the accidents is made by analyzing a variable which
measure the status of having/not having an accident in the last 12 months. The
status of not having any kind of accident is present at 99.5% of respondents, while
0.4% of respondents suffered in the last year an accident. An insignificant percent
(0.1%) were refusals. The type of accident suffered by respondent s is present in the
figure 1.
The territorial distributi on of respondents who have suffered a non -car
accident is not uniformly distributed. There are several factors which contribute to
this variability. Since main categories of non -car accidents imply work accidents
and home and leisure accidents, one determi nant of variability could be the
regional economic development.
In the Figure 2, it can be observed the distribution of non -car accident in
Romanian regions. Large values of share of accidents are characteristic to less
developed regions like North -East (3 .4%) or South -West region (1.6%). Pearson
correlation coefficient estimated using share of accidents and regional household
average income2 is -0,51, statistically significant at level of 5%. Presence of higher
frequency of accidents in less developed area may occur because of work/job type

1http://epp.eurostat.ec.europa.eu/portal/page/portal/microdata/documents /EHIS_wave_1_gu
idelines.pdf
2Source: National Institute of Statistics, Tempo online, Ancheta Bugetelor de Familie, 2008

Ruxandra S inescu, Andrea A nghel, Catalina A ndrei, E. Hert eliu, B. I leanu
__________________________________________________________________
distribution. In North East, South -West and South region the share of agriculture
and some heavy industries, lik e mining or petroleum exploitation, domains with
higher risk of work accidents may contribute to share variation.

Figure 1. Share of respondents by type of accidents suffered in the last year by
the respondents

Figure 2.Regional share of respondents who suffered a non -car
accident in the last 12 months

0,2% 0,4%
0,1% 1,3%
0,0% 0,5% 1,0% 1,5%
Road traffic
accident Work accident Accident at
school Home and
leisure acident
North -West 1.5%, Cent er 1.8% , Nor th-East, 3.4% , South-East 1.4% , South 1.6% , Buc harest –
Ilfov, 0.9%, South-West1.6% ,West 0.6%

Non-car Accidents and Treatment in Plastic S urgery
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The next step of the analysis is to see if some social and behavioral factors
are increasing the risk of having accidents. The answer of this question is given by
the results of the following logit model having as the d ependent variable the status
regarding the accidents suffered in the last year except the road and traffic
accident. The variable is used in the model as ACC.
We consider the conditional average the proportion of
respondents who suffered an acc ident in the last 12 months. In this case
=pi*1 + (1 -pi)*0=p i, where x i are the determinants of the result. Now we let be
pi=f(X’b) and using logistic distribution we achieve the following relation:

where X= the vector of determinants

and

The following determinants are used in the model:

Socio -demographical covariates:
gender ( SEX ), (1=males, 0=females) –
age, (AGE), a continuous variable with values between 18 and 96 years
old;
education , (EDU) ordinal scaled with 7 levels where 1 =no formal
education and 6= second stage of tertiary education
body mass index (BMI) obtained by dividing the body mass by square
height in meters .

Work -load and lifestyle covariates:
Home -exposure at risks (HSHREXP) is measured on 3 point ordinal scale
having code 1 for severely exposure and code 3 for non -exposure of noise,
air pollution, etc.
Work -exposure at risks (WKEXP) is measure on a 3 point ordinal scale
with code 1 representing severe exposure and code 3 no exposure. Work
exposure at risks measures if the respondents have to do difficult work

Ruxandra S inescu, Andrea A nghel, Catalina A ndrei, E. Hert eliu, B. I leanu
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postures, work movements, handling of heavy loads due to the specif ic of
work
Work -exposure at accident risks (WKACC) measured also on a 3 point
scale as the above mentioned variables;

Main Results
After maximum likelihood estimation the results presented in the next
table are achieved.

Table 1. Risk factors and their statistical significance
Dependent variable=ACC S.E. Wald df Sig. Exp( )
EDU -.187 .100 3.455 1 .063 .830
BMI .033 .023 1.990 1 .095 1.033
AGE .014 .007 3.622 1 .057 1.014
SEX .490 .194 6.374 1 .012 1.632
WKACC -.256 .167 2.350 1 .125 .774
HSHREXP .184 .145 1.607 1 .205 1.202
WKEXP -.522 .164 10.079 1 .001 .593
Constant -3.546 .898 15.592 1 .000 .029
Source: Own calculation based on Romanian EHIS database

Most of the estimated coefficients are statistically significant at levels
below 5% (like Gender, work exposure at risk, etc) or 6% to 10% levels (like Age,
education, body -mass index, etc .).
Overall econometric validation is made by Hosmer -Lemeshow goodness
of fit test and Nagelkerke, Cox & Snell Pseudo R Squared statistics.
The eco nomic and health validation is discussed in the next paragraphs:
The level of education is a significant factor in risk. More educated
persons have lower risks of accidents. This thing is a result of two components: a)
respondent knowledge and experience a bout risks determine him to a better
avoidance of risk and b) type of occupation/job. Respondents more educated have
type of jobs exposed to lower risks. Generally the model shows that for each level
of education graduated, the risk of accidents decreases by 17%.
Body mass index (BMI) is also an important determinant of risks. Over
heighted persons are more exposed of risks. For example, for one unit increase of
BMI index, the risk of accident increases by 3%. This could be explained by the
thing that over heighted persons are putting more pressure on their skeletal system
and also by slowly movement in day by day activities.
Males are 60% more exposed to risk of accidents than females, mainly
because of their work activity (heavy industry, agriculture, poli ce, but also by their

Non-car Accidents and Treatment in Plastic S urgery
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life style more risky like sports, car or motor -driving, skiing or climbing, etc) . Also
the model reveals that getting older by 10 years determines a risk increase by 14%.
Work accident exposure show that the decreasing degree of ex posure
determines a positive impact on decreases of general risk of accidents by 23%.
Household exposure to general risk (smog, pollution, dust, grime, etc.) doesn’t
impact statistically significant the general risk of accident.
Perhaps one of the most imp ortant risk is type of occupation: Authors
calculation reveals that people working as Legislators and senior officials, as
general managers or as agricultural, fishery and related laborers, market -oriented
skilled agricultural and fishery workers,precision , handicraft, printing and related
trades workers, extraction and building trades workers,personal and protective
services workers, etc3 are exposed to higher risk of accidents.
A more detailed structure by type of accidents suffered by people working
in each field with higher risks is revealed in the Figure 3.

Figure 3. Structure of accidents by type of respondent occupation

Legislators, senior officials and general managers, as expected, have
suffered accidents only at home or at relaxation, recreati on, probably in holidays.
A special category of respondents is given by personal and protective service

3According OECD -ISCOM -88 Classification. 100% 100%
51% 82%
32% 40% 81% 0% 0%
49% 18%
68% 60% 19%
0% 20% 40% 60% 80% 100%
Legislators and
senior officials General
managers Agricultural,
fishery and
related
labourers Market -oriented
skilled
agricultural and
fishery workers Precision,
handicraft,
printing and
related trades
workers Extraction and
building trades
workers Personal and
protective
services
workers Home and leisure Work accident

Ruxandra S inescu, Andrea A nghel, Catalina A ndrei, E. Hert eliu, B. I leanu
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workers, a category where employees are high exposed to high risks by nature of
work. On the contrary the employees suffered accidents mostly during the ir free
time, and only 19% of them at work. Expected results were found in domain like
agricultural, fishery, handicraft and building trades workers where a significant
part of respondents suffered accidents at their workplace.
The severity of accidents.
As a result of an accident in most of the cases there is a need of seeing a
doctor in emergency or in a scheduled meeting. In the case of accident at work,
53.1 % of persons are going to a form of medical care. In the case of school
accidents 71% of persons visited a doctor or a nurse but none of the respondents
went to an emergency department, meaning that all the cases of youngsters had not
severe injuries or traumas. Accidents at home or leisure accidents needed in 61%
of cases medical interventions.

Conclusions

It can also be underlined that non -work accident are statistically more
frequent in thinly -populated area than in densely or intermediate areas, degree of
urbanization being a factor correlated with other factors described above or
included in t he econometric model like occupation, age, education. Usually thinly –
populated areas are more frequent in the rural area .

Acknowledgments
This paper was co -financed from the European Social Fund, through the
Sectoral Operational Programme Human Resources Development 2007 -2013,
project number POSDRU/159/1.5/S/138907 "Excellence in scientific
interdisciplinary research, doctoral and postdoctoral, in the economic, social and
medical fields -EXCELIS", coordinator The Bucharest University of Economic
Studies.
ii) This work was cofinanced from the European Social Fund through Sectoral
Operational Programme Human Resources Development 2007 -2013, project
number POSDRU/159/1.5/S/134197 „Performance and excellence in doctoral
and postdoctoral research in Romanian economics science domain” .

Non-car Accidents and Treatment in Plastic S urgery
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