What to Know About Surgery in Your Doctor's Office

Surgery, once upon a time, was almost solely confined to the hospital operating room. Today, many surgeries are being performed in ambulatory or "outpatient" settings-and a growing number are taking place right in the doctor's office. In many cases, office-based surgery is more affordable and more convenient for the patient.

A recent television broadcast focused on this trend, leading off with the tragic report of a nine-year-old girl who died on the doctor's operating table while undergoing relatively simple ear tube surgery. Out-dated and malfunctioning anesthesia equipment in the doctor's office was identified as a cause.

Is surgery in the doctor's office risky? What's hype-what's truth? And what do you need to know before consenting to a surgical procedure in your doctor's office?

Regulation of Office Surgical Facilities

State regulation
In-office surgery is not regulated in most states. In fact, only four states currently have comprehensive laws covering surgeries and anesthesia in doctor's offices-New Jersey, California, Florida and Texas.

Voluntary regulation
But doctor's offices that do surgery can voluntarily have their surgery practice accredited, licensed or certified - an assurance that the facility meets high standards for patient safety and complies with local, state, and federal codes.

The American Association for Accreditation For Ambulatory Surgery Facilities (AAAASF) is a voluntary program of inspection and accreditation in surgery facilities. Surgeons working in AAAASF-accredited facilities must be board-certified and have equivalent hospital surgical privileges.

What's the safety record of these accredited office surgical facilities? "Excellent," concludes research commissioned by the AAAASF. What's more, the study shows that overall risk is comparable to a free-standing or hospital ambulatory surgical facility.

The experts Dateline spoke to recommended that if you are going to have surgery in an office, ask if it meets one of the following standards:

• Accredited by an accrediting organization such as the Joint Commission on Accreditation of HealthCare Organizations (JCAHO); or Accreditation Association for Ambulatory Health Care (AAAHC); or American Association for Accreditation of Ambulatory Surgery Facilities, Inc. (AAAASF)
• Licensed as an ambulatory surgical center by the state
• Certified as an ambulatory surgical center by the Medicare program

Know Your Doctor's Credentials
What about your surgeon's qualifications? If you are unsure, ask him, or direct your inquiries to your local or state medical society, advises the American College of Surgeons. Take note: Any doctor can call himself a plastic, facial plastic, or cosmetic surgeon. Find out whether he is board-certified or board-eligible and in what specialty. "One good sign of a surgeon's competence is certification by a national surgical board approved by the American Board of Medical Specialties. All board-certified surgeons have satisfactorily completed an approved residency training program and have passed a rigorous specialty examination," according to the American College of Surgeons.

Anesthesia
What about anesthesia in doctor's-office surgery? The American Society of Anesthesiologists takes the position that ambulatory (or outpatient) anesthesia and surgical care "has been proven to be safe, convenient and cost-effective."

Talk to your doctor about the kind of anesthesia you will need and the risks associated with it. The person giving you anesthesia should be an anesthesiologist, a certified nurse anesthetist, or a physician with credentials in anesthesia. Ask questions about the doctor's office surgical room: Is a heart monitor used? How close is the nearest hospital? Is the anesthesia equipment inspected, calibrated and regularly maintained? Is it equipped with the latest safety devices? In LASIK eye surgery procedures, what kind of microkeratome is used and how often is the microkeratome blade changed? How often are the laser and microkeratome serviced? (You can check with the manufacturer for recommendations.) How many nurses work with the surgeon? Who assists? Is there a recovery room? Are emergency procedures in place? Is the surgeon trained in ACLS, Advanced-Cardiac Life Support? Who runs the operating room? Ask to see the room; is it tidy, clean and organized?

Don't be intimidated about asking questions. A caring, competent surgeon will understand that you are being thorough and will be willing to address your concerns.

Believe Your Instincts
Trust your first impression and trust your surgeon, writes Elizabeth Morgan, M.D., F.A.C.S., in "The Complete Book of Cosmetic Surgery: A Candid Guide for Men, Women & Teens." Ask to see the operating facility. "If the operating room doesn't look right, say that you prefer a hospital or surgery center," cautions Dr. Morgan.

"If you have a good surgeon, trust him. Good surgeons take good care of their patients. A conscientious surgeon will do your surgery where it is safe for you. You can't be an office accreditation committee."

More to Know

• The AAAASF research project set out to identify complications and deaths related to in-office surgery and compare data with other outpatient surgery data. A questionnaire was sent to 418 accredited facilities; 241 (or 57 percent) responded. The study found that significant complications (hematoma, hypertensive episode, wound infection, sepsis, hypotension) were infrequent, occurring in 1 in every 213 cases. A death occurred in 1 in 57,000 cases (0.0017 percent). "This study documents an excellent safety record for plastic surgery done in accredited office surgical facilities by board-certified plastic surgeons," the report concluded.
• Dateline NBC queried medical boards in all 50 states. The District of Columbia and 43 states reported that they have no rules specifically regulating surgeries in a private doctor's office. Three states-Virginia, Illinois, and Missouri-reported some kind of regulation. Four states currently have comprehensive laws covering surgeries and anesthesia in doctor's offices-New Jersey, California, Florida and Texas.
• According to the AAAASF, studies have shown that costs to a patient in a single-specialty facility, such as an accredited surgery facility, are only one-third to one-half those charged by a hospital for the same procedure.
• The American Society for Aesthetic Plastic Surgery (ASAPS) 1999 Statistics show that 53 percent of cosmetic procedures were performed in an office-based surgical facility.

Getting Started
If you are considering a cosmetic medical procedure, consult a board-certified plastic surgeon about the process, risks, recovery time and costs.