Home E-Weekly February 12, 2008

Office Surgery Safety Under Scrutiny

Published: February 11, 2008

The dangers of office-based surgery are once again making headlines. For a study published online by the journal Dermatologic Surgery, researchers summarized seven years of prospective data on office surgery incidents in Florida.

According to the study, about half of all deaths and injuries resulting from office surgery incidents between 2000 and 2007 involved cosmetic procedures performed by board-certified plastic surgeons administering general anesthesia. The researchers counted a total of 31 deaths and 143 procedure-related complications and hospital transfers.

Liposuction procedures, performed either alone or in conjunction with abdominoplasty or other cosmetic surgeries, resulted in eight of the 31 deaths - they were the most common cause of death - and 24 cases of complications. Seven of the eight patients who died were administered general anesthesia. Four of the deaths were attributed to pulmonary emboli and three to unknown causes. All eight patients died several hours to nine days following uneventful discharges.

"It should be noted that all cosmetic procedures except abdominoplasty can be performed under local anesthesia, albeit with less convenience for the patient and surgeon," the researchers write.

Meanwhile, Arizona has enacted new regulations for doctors who perform office-based surgeries outside of hospital or ASC settings using sedation. The rules, developed by the Arizona Medical Board and approved last month, state that offices must be equipped to perform the procedure safely, to administer and monitor sedation and to rescue a patient who enters a deeper state of sedation than intended.

Doctors must also ensure that staff members assisting them in such procedures have sufficient education, training and experience. In addition, the physician must be certain that the patient is able to leave the office within 24 hours following the procedure. The rules prohibit doctors from performing office-based procedures using sedation if the patient has a condition that indicates surgery should not be done there or if the patient's condition will require inpatient services at a hospital. After surgery, a doctor must be present in the office and able to respond to any emergencies until the patient's post-sedation monitoring is discontinued.

Dan O'Connor

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