Office Surgery: Surgery in an ACCREDITED Office Surgical Facility is a Safe Alternative to Hospital-Based Surgery

PROMISES

Appropriate surgical procedures, carried out by a qualified surgeon in an ACCREDITED, well-run and maintained office surgical facility can be:

• A positive, non-threatening experience for the patient
• In an effective surgical environment
• A completely private experience
• More economical for the patient
• More convenient for patient and surgeon alike
• But, most importantly: SAFE
   

PITFALLS

Surgery once restricted to the hospital operating room is now being done more and more frequently in the physicians’ offices. This is particularly true of cosmetic surgery since the patients, not insurance companies, who pay for it. What’s the difference about where it is done?

Just as there is no regulation of who can call themselves cosmetic or plastic surgeons, (see Promises and Pitfalls: Credentials - The Importance of Credentials) there is little regulation of what surgery can and can’t be done in an office. Unfortunately, there is an alarming indication that the public's safety is being compromised by this lack of regulation. The State of Florida Board of Medicine recently placed a moratorium on office surgery performed under general anesthesia and heavy sedation due to a high incidence of hospital admissions from complications of office procedures.

And along with numerous other states, Florida has passed legislation regulating office surgery. How can a patient protect his/her safety in regard to surgical facilities recommended for a cosmetic procedure?

• Most critical is the choice of a surgeon, because the patient must trust in the surgeon's judgment in regard to all aspects of care - the facility being only one of those aspects (see Promises and Pitfalls: Credentials).
  
• If office surgery is recommended:
  • Is the facility accredited? By what authority? There are three recognized accreditation agencies: AAAASF, AAAHC, and JCAHO.
  • Does the surgeon have hospital privileges to perform the same procedure in the hospital? Since accreditation organizations certify facilities, knowing that the surgeon is privileged by a major hospital assures the patient that he/she has been approved by the hospital to perform a particular procedure.
  • What type of anesthesia is planned and who will administer it? (See Promises and Pitfalls: Anesthesia - Gain without Pain)
  • What are the recovery arrangements? And aftercare arrangements? Anesthetic and surgical complications are independent of the facility, and can occur when least expected. While accreditation is not a guarantee, it is means that the facility has met national safety standards. Having surgery in a non-accredited facility provides no objective assurance of safety.

• Our office surgical facility is accredited for IV SEDATION by the American Association for Accreditation of Ambulatory Surgical Facilities (AAAASF).
   
• AAASF accreditation standards are often referred to as the “Gold Standard” in the industry, and AAAASF has hard statistics to document that surgery performed in one of AAAASF accredited facilities is at least as safe -- if not safer -- than comparable procedures performed in a hospital setting. AAAASF has  published two reports in the scientific literature (in 1997 and 2004, with a third to be published this year) documenting the safety of surgery at their accredited facilities with over 1 million consecutive patients.
   
• Nurse anesthetists and OR nursing personnel are appropriately credentialed by the State of Texas and have hospital privileges.
   
• Surgeons are certified by the American Board of Plastic Surgery and have hospital privileges to perform all procedures done in the office. (Presbyterian Hospital of Dallas, Presbyterian Hospital of Allen)
   
• Equipment, staffing, procedures and maintenance meet AAAASF standards (similar to hospital standards).
   
• All intravenous sedation and patient monitoring are provided by a certified registered nurse anesthetist (CRNA).
   
• Most patients are able to leave the office within 30-60 minutes recovery.
   
• Aftercare is provided for selected procedures (for example, facelifts).
   
• The office has an extremely low incidence of complications related to surgery, anesthesia and surgical facility. (More than 5000 cases have been done in our facility without a significant anesthetic complication.)