Office surgery safety breakthrough

A major study documenting outcomes for more than 400,000 surgical procedures performed in accredited office-based surgery facilities provides solid data confirming an overall safety record comparable to that of surgeries performed in hospital surgery facilities. The study was previewed at the Annual Meeting of the American Society for Aesthetic Plastic Surgery (ASAPS) in Vancouver , BC .

The analysis was based on data collected by the American Association for Accreditation of Ambulatory Surgery Facilities (AAAASF), the nation's largest organization for accreditation of office-based surgery centers, through its Internet-based Quality Improvement and Peer Review Program. Michael McGuire, MD, ASAPS Public Education Chair and AAAASF President said that the AAAASF had developed the innovative Internet-based reporting program to provide in-depth analysis of surgical outcomes for its accredited surgery centers. “This program is significant,” says Dr. McGuire, “because for the first time there is a mandatory central data collection system to assess the quality of care delivered in office-based outpatient surgery centers.”

In the AAAASF study, outcomes data were obtained from 621 surgery centers over a two-year period and statistically analyzed. The accreditation standards for AAAASF require all unanticipated issues to be reported, ranging from complications such as hematoma (abnormal accumulation of blood) to patient complaints and surgery cancellations. In total, 411,670 procedures were analyzed from 2001 through 2002. Eight deaths were reported, occurring in one in 51,459 procedures (0.00l9 percent). The overall risk of death was comparable whether the procedure was performed in an AAAASF-accredited office surgery facility or a hospital surgery facility.

It is important to note that of the eight deaths reported in the study, six were related to pulmonary embolism, which can occur as the result of any surgical procedure, wherever it is performed.

Dr. McGuire says that this report demonstrates conclusively the safety of operations performed in outpatient surgery centers that are accredited by a recognized accrediting organization and staffed by American Board of Medical Specialties (ABMS) certified surgeons. AAAASF mandates that surgeons performing operations in accredited office-based facilities have privileges to perform the same operations in an accredited hospital.

The American Society of Anesthesiologists reports that by the year 2005, an estimated 10 million procedures will be performed annually in doctors' offices, twice the number of office-based operations performed in 1995. “This is a dramatic increase that reinforces the need for accreditation as a means of helping to ensure patient safety,” says Robert Singer, MD, immediate past president of the not-for-profit Aesthetic Surgery Education and Research Foundation (ASERF).

In 1999, the nation's two major societies of board-certified plastic surgeons, the American Society for Aesthetic Plastic Surgery (ASAPS) and the American Society of Plastic Surgeons (ASPS), each passed a mandate stipulating office accreditation for their members who perform outpatient operations under sedation or general anesthesia. ASAPS Immediate Past President Robert Bernard, MD, who moderated a Patient Safety Panel at the ASAPS Annual Meeting, says that it is important for plastic surgeons not only to educate each other but also to educate the public about patient safety issues. “The public has to know what questions to ask so that they can make the right decisions about their medical and surgical care,” he says. ASAPS President Peter Fodor, MD, says, “Patient safety will continue to be a priority for proactive initiatives by the American Society for Aesthetic Plastic Surgery.”

Drs. McGuire and Singer are among the authors of a peer-reviewed article based on the AAAASF study which is published in the May issue of Plastic and Reconstructive Surgery , official organ of the American Society for Aesthetic Plastic Surgery. Geoffrey Keyes, MD, lead author of the article, says that plastic surgeons were the first specialists to support mandatory accreditation of office-based surgical facilities. “Currently only fourteen states have mandated accreditation of surgery centers. This number should continue to increase until accreditation becomes the national standard,” he says.