In Office Surgery: 12 Times More Complications and Injury Reported
In Office Surgery: 12 Times More Complications and Injury Reported
Considering having surgery in a doctor’s office in the near future? Well, it’s 12 times more likely to kill or injure you than having it done in a hospitial according to a new study published in the Archives of Surgery. The study’s author, Dr. Vila, M.D., reports patients died nearly 12 times more often in surgery during office visits. They also suffered injuries 12 times more often. Many of the unnecessary and avoidable deaths and injuries happened when surgery during office visits was performed by doctors who weren’t board certified.
A shocking fact is only twenty-two states have some regulations or guidelines on office-based surgical procedures. Plumbers and hot dog vendors are more regulated by state laws than surgery performed in a doctor’s office!
There are many reasons for this dramatic difference, Vila says. They include lack of equipment and personnel, lack of set procedures, and the inability to deal with emergencies. “Sometimes it’s the credentials of the people performing the procedure or administering the anesthesia,” Vila adds.
“If you go to work in a hospital, as a physician you have to apply for privileges, but as a private physician you can do whatever you want in your office,” Vila says. “You don’t have to show to anyone that you are able to do the procedure. You just open your office and do it.”
Vila believes this is a new problem in medicine, and it comes down to money. Office surgeries are much cheaper than those done in ambulatory surgery centers.
We have obtained an abstract of the study below:
Comparative Outcomes Analysis of Procedures Performed in Physician Offices and Ambulatory Surgery Centers
Authors: Hector Vila, Jr, MD; Roy Soto, MD; Alan B. Cantor, PhD; David Mackey, MD
Arch Surg. 2003;138:991-995.
Hypothesis This study compared outcomes to determine whether patient safety is similar in Florida ambulatory surgery centers and offices.
Data Sources All adverse incident reports to the Florida Board of Medicine for procedure dates April 1, 2000, to April 1, 2002 were reviewed. The numbers of office procedures performed during a 4-month period were used to estimate the total number of procedures. Ambulatory surgery death summaries, adverse incident data, and volumes of procedures for 2000 were procured from the Florida Agency for Health Care Administration.
Study Selection/Data Extraction Adverse incident reports were reviewed by multiple parties; only reports that involved an office surgical procedure and resulted in injury or death were included in the outcomes calculation. Reports were extracted independently by multiple reviewers.
Data Synthesis Adverse incidents occurred at a rate of 66 and 5.3 per 100 000 procedures in offices and ambulatory surgery centers, respectively. The death rate per 100 000 procedures performed was 9.2 in offices and 0.78 in ambulatory surgery centers. The relative risks for injuries and deaths for office procedures vs ambulatory surgery centers were 12.4 (95% confidence interval, 9.5-16.2) and 11.8 (95% confidence interval, 5.8-24.1), respectively.
Conclusions In this review of surgical procedures performed in offices and ambulatory surgery centers in Florida during a recent 2-year period, there was an approximately 10-fold increased risk of adverse incidents and death in the office setting. If all office procedures had been performed in ambulatory surgery centers, approximately 43 injuries and 6 deaths per year could have been prevented.
Recommendations that could save your life!
The author of the study has a few recommendations for those considering risky in office surgery.
“You should ask if your doctor has the same standards as those used in the hospital or ambulatory surgical center. Are the physicians board-certified to do the procedure? Do they have the same equipment? Do they have emergency resuscitative equipment? Who is going to be giving the anesthesia? And, where will you be taken if there is an emergency?”
