• Surgery at the Doctor's Office: What You Need to Know

    IMAGE Surgeries that were once performed only in a hospital or surgery centers are becoming more common in converted examining rooms and surgical suites in physicians' offices.
    Many of these procedures require general anesthesia or intravenous (IV) sedation. Yet, in some states, there are few standards, regulations, or accreditation requirements for surgeries performed in physician offices.
    Considering the complexity of some surgery, and the anesthesia used, you may wonder if this trend is a safe one. If you have a doctor that wants to use the office for your next surgery, here is some information to get you started.

    Safety Concerns

    Without the same safety regulations as hospital surgery, office-based surgeries could cause serious complications. There have been reports of deaths resulting from the following situations:
    • Staff was unprepared and untrained to manage cardiac arrest or breathing problems
    • Staff called 911 too late or not at all, for fear of reporting
    • Drugs and/or equipment were outdated
    • Lengthy surgery was done on a medically unfit patients
    Regulation requirements differ among states. Make sure you check them before you have your surgery.

    Why Have Surgery in the Office?

    The trend toward office-based surgery is driven by several factors, including:
    • Cost
    • Patients' wishes for privacy and convenience
    • Flexibility in scheduling
    • Wider availability of smaller patient monitors and other surgical and anesthesia equipment
    • Newer anesthetics that work faster and wear off more quickly

    Standards

    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. On the other hand, inconsistent standards exist for office-based surgery. Some states have addressed the issue of office-based surgery and implemented regulatory requirements while others are relatively unregulated.
    There are efforts to standardize surgical safety for office-based procedures. For example, the American Society for Anesthesiologists has created guidelines for office-based anesthesia. Also, the Institute for safety in Office-Based Surgery (ISOBS) created checklists which covers items from the preoperative period through discharge to help keep patients safe.

    The Anesthesia Factor

    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.

    Who Should Not Have Surgery in a Doctor's Office?

    Regardless of how minor the surgery, certain patients, particularly those with serious health conditions, such as heart disease, or uncontrolled high blood pressure, should not have surgery in a physician's office.

    Be Informed

    Before you have surgery in a doctor's office, the American Society of Anesthesiologists recommends that you ask the following questions:
    • Is the office accredited for surgery and anesthesia?
    • Does the doctor have credentials to perform the surgery in a hospital or outpatient surgery center?
    • Will a qualified anesthesiologist or certified registered nurse anesthetist (supervised by an anesthesiologist or other qualified physician) give the anesthesia? (You should meet this person before your surgery, and she should remain with you until you wake up.)
    • Is the anesthesia equipment equivalent to that used in a hospital or ambulatory surgical facility?
    • Does the doctor have the necessary equipment and drugs to handle any emergencies?
    • Which hospital will you be admitted to if complications occur?
    • Will qualified and trained staff monitor your recovery?
    • Is the recovery area equipped similarly to one in a hospital or ambulatory surgery facility?
    • Will a physician decide if you are ready to be discharged? (A nurse could follow a doctor's orders based on objective criteria.)
    • Is someone in the office certified in advanced cardiac life support (ACLS)?
    • If a child is having the surgery, is someone trained in pediatric life support? Are equipment and drugs specifically for children available?
    As a patient, you should to be aware of the risks and benefits of surgery in any setting. If you have any concerns or questions, make sure you talk to your doctor.

    RESOURCES

    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%5Fe.html

    References

    Failey C, Aburto J, de la Portilla HG, et al. Office-based outpatient plastic surgery utilizing total intravenous anesthesia. Aesthet Surg J. 2013;epub.

    Guidelines for office-based anesthesia. American Society of Anesthesiologists website. Available at: http://www.asahq.org/For-Members/Standards-Guidelines-and-Statements.aspx. Updated October 21, 2009. Accessed January 24, 2013.

    Haugh R. Competition keeps getting hotter for ambulatory surgery. Hosp Health Netw. 2006;80:68-70,72.

    Horton JB, Reece EM, Broughton G 2nd, et al. Patient safety in the office-based setting. Plast Reconstr Surg. 2006;117(4):61e-80e.

    Office-based surgery benefits. The Center for Menstrual Disorders and Reproductive Choice website. Available at: http://www.cmdrc.com/menstrual-disorders-a-fibroids/office-based-surgery-benefits. Accessed January 24, 2013.

    Office-based surgery summary of provisions. American Society of Anesthesiologists website. Available at: http://www.asahq.org/for-members/advocacy/state-legislative-and-regulatory-issues/office-based-surgery.aspx. Accessed January 24, 2013.

    Patient's checklist for office-based procedures. Institute for Safety in Office-Based Surgery website. Available at: http://isobsurgery.org/wp-content/uploads/2012/03/patient-checklist.jpg. Accessed January 24, 2013.

    Safety checklist for office-based surgery. Institute for Safety in Office-Based Surgery website. Available at: http://isobsurgery.org/wp-content/uploads/2012/03/safety-checklist.jpg. Accessed January 24, 2013.

    Surgical safety checklist. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what. Updated August 4, 2012. Accessed January 24, 2013.

    Urman RD, Punwani N, Shapiro, F. Office-based surgical and medical procedures: Education gaps. Ochsner J. 2012;12(4):383-388.

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