Surgeries that were once performed only in a hospital or surgery center are becoming more common in converted examining rooms, surgical suites in physicians' offices or outpatient surgery centers.
Many of these procedures require general anesthesia or intravenous (IV) sedation. Yet, in most states, there are no standards, regulations, or accreditation requirements for surgeries performed in physician offices.
"It used to be that the only [procedures] done in physician offices were dermatologic or plastic surgery, primarily under a local anesthetic," says Rebecca Twersky, MD, a New York-based anesthesiologist who helped write the American Society of Anesthesiologists' guidelines for office-based anesthesia. "Now we're seeing oral surgery, orthopedics, podiatry, and general surgery."
Dr. Twersky warns that without the same safety regulations as hospital surgery, office-based surgeries could cause serious complications. There have already been reports of deaths resulting from the following situations:
The trend toward office-based surgery is driven by several factors, including:
But the biggest reason for the increasing popularity of office-based surgery may be cost.
A procedure performed in an outpatient surgery setting costs up to half of what it costs in the hospital, says Ronald E. Iverson, MD, a plastic surgeon in Pleasanton, California, and former president of the American Association for the Accreditation of Ambulatory Surgery Facilities (AAAASF). Performing surgery in the doctor's office saves even more money. Physicians also like scheduling their own surgeries on their own time, according to Dr. Iverson.
What worries Twersky, Iverson, and others is the lack of state or federal oversight of office surgeries. Dr. Iverson says that these procedures should be governed by the same standards as those performed in ambulatory care centers.
Hospitals and surgery centers must meet strict state and federal licensing and accreditation guidelines. They also have medical boards that oversee practitioners' qualifications and credentials. Inconsistent standards exist for office-based surgery. Some states (ie California, Florida, New Jersey, Pennsylvania, Rhode Island and Texas) have addressed the issue of office based surgery and implemented regulatory requirements while others are relatively unregulated.
The type of anesthesia used in surgery is an important safety concern, Dr. Iverson explains. Once you move from local anesthesia to IV sedation or general anesthesia, the risk for complications such as respiratory distress or heart attack increases. In rare cases, patients can even have a life-threatening reaction to local anesthesia, says Dr. Twersky.
Regardless of how minor the surgery, certain patients, particularly those with serious health conditions, such as diabetes , heart disease, or uncontrolled high blood pressure , shouldn't have surgery in a physician's office, says Dr. Twersky.
Before you have surgery in a doctor's office, the American Society of Anesthesiologists recommends that you ask the following questions:
"We're not saying don't have the surgery in a physician's office," says Dr. Twersky. "But be aware of the risks involved and make sure that you're safeguarding yourself."
RESOURCES:
Accreditation Association for Ambulatory Health Care, Inc.
http://www.aaahc.org/
American Association for the Accreditation of Ambulatory Surgery Facilities, Inc.
http://www.aaaasf.org/
American Society of Anesthesiologists
http://www.asahq.org/
Joint Commission on Accreditation of Healthcare Organizations
http://www.jcaho.org/
CANADIAN RESOURCES:
Canadian Anesthesiologists' Society
http://www.cas.ca/
Health Canada
http://www.hc-sc.gc.ca/index_e.html
References:
Haugh R. Competition keeps getting hotter for ambulatory surgery. Hosp Health Netw. 2006;80:68-70,72.
Last reviewed January 2009 by Mervin Low, MD, PC
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