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,
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