SKing, if I'm not mistaken, I think that you've seen HOMS... sanitary conditions are on par at CECIP; which is basically as good as it gets in DR. They are not the same as let's say U of Penn Hospital; which is a world class hospital and I'm very familiar with, but you also don't commonly hear about unsanitary conditions or the spread of infections there, as you do at many other clinics or public hospitals in DR.
Now, I'll repeat what I've said previously. If it was me getting the surgery, I would do it in the US, and I would go through the same careful and extensive research process for selecting a surgeon. God knows that we have plenty of crappy doctors here too!