An excerpt from the Johns Hopkins Medical Letter: Health After 50 Is it safe to have surgery in your doctor's office? Hidden risks when elective surgery is an office procedure
The trend is clear: from cosmetic liposuction to cataract and hernia treatments to colonoscopies, an estimated 20% of all elective surgeries now take place in a doctor's office. Pressure from health care insurers to reduce costs is only one reason for the move away from hospitals and ambulatory surgery centers (ASC.) Convenience for the patient and a less intimidating environment can make the doctor's office seem more appealing than a hospital. 10 times more deadly than a hospital setting The risk of complications is significantly greater for patients who undergo the in-office procedures. One study, reviewing data on outpatient surgeries performed in Florida doctors' offices over a 2-year period, found the risk of complications or death was ten times greater than in a traditional setting. It's worth noting that Florida had already begun to institute regulations to improve patient safety. In states that are more lax, this kind of information isn't available and the risk of in-office procedures may be even higher. What are the real risks? Lack of regulation. Both hospitals and ASCs are highly regulated by government agencies, but physicians offices are not usually overseen by state agencies. Only a few states require that complications be reported. Lack of oversight. New reports have revealed instances of doctors who perform surgery in their offices without proper training, outside their specialty area, or with improper instruments. In most states, office staffs are not required to have the training required for ASC or hospital staffs. Equipment may be inferior, and an anesthesiologist need not be present. Inadequate patient screening. Being older, and having other health problems, raise the risks. Anyone with a serious medical condition should carefully consider and discuss the risk of complications with the doctor performing the procedure. Coronary heart disease and respiratory conditions such as asthma or chronic obstructive pulmonary disease (COPD) must be well-managed and stable for office surgery to be safe.
Before you agree to an in-office procedure: Is the office licensed or accredited? Your state medical board can tell you if your state has regulations for office-based procedures. If so, ask if your doctor's facility is state licensed. Is your doctor qualified to do the procedure? The doctor should be board certified by the appropriate professional board and have privileges to perform the procedure at a hospital. Who will administer the anesthesia? It should be administered by a board-certified anesthesiologist or a certified registered nurse anesthetist supervised by a physician. How are emergencies handled? Check that the office has an efficient way to transfer you to a nearby hospital in the unlikely event of a complication. Who monitors your recovery? The recovery area should have monitoring equipment equivalent to that used in a hospital or ASC. A physician or nurse should be available until you are fully recovered. For more healthy living advice for men and women over 50, subscribe today to Johns Hopkins Medical Letter: Health After 50. "As a subscriber to the Johns Hopkins Medical Letter (Health After 50), I always look forward to the next issue to read about additional health issues for seniors. I am a 77-year-old male and in good health." - E.C., Glendale, CA

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