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Surgery at the Doctor's Office: What You Need to Know
- Staff was unprepared and untrained to manage cardiac arrest or breathing problems
- Staff called 911 too late or not at all, for fear of reporting
- Drugs and/or equipment were outdated
- Lengthy surgery was done on a medically unfit patients
Why Have Surgery in the Office?
- Patients' wishes for privacy and convenience
- Flexibility in scheduling
- Wider availability of smaller patient monitors and other surgical and anesthesia equipment
- Newer anesthetics that work faster and wear off more quickly
The Anesthesia Factor
Who Should Not Have Surgery in a Doctor's Office?
- Is the office accredited for surgery and anesthesia?
- Does the doctor have credentials to perform the surgery in a hospital or outpatient surgery center?
- Will a qualified anesthesiologist or certified registered nurse anesthetist (supervised by an anesthesiologist or other qualified physician) give the anesthesia? (You should meet this person before your surgery, and she should remain with you until you wake up.)
- Is the anesthesia equipment equivalent to that used in a hospital or ambulatory surgical facility?
- Does the doctor have the necessary equipment and drugs to handle any emergencies?
- Which hospital will you be admitted to if complications occur?
- Will qualified and trained staff monitor your recovery?
- Is the recovery area equipped similarly to one in a hospital or ambulatory surgery facility?
- Will a physician decide if you are ready to be discharged? (A nurse could follow a doctor's orders based on objective criteria.)
- Is someone in the office certified in advanced cardiac life support (ACLS)?
- If a child is having the surgery, is someone trained in pediatric life support? Are equipment and drugs specifically for children available?
American Society of Anesthesiologists http://www.asahq.org
Joint Commission on Accreditation of Healthcare Organizations http://www.jcaho.org
Canadian Anesthesiologists Society http://www.cas.ca
Health Canada http://www.hc-sc.gc.ca/index%5Fe.html
Failey C, Aburto J, de la Portilla HG, et al. Office-based outpatient plastic surgery utilizing total intravenous anesthesia. Aesthet Surg J. 2013;epub.
Guidelines for office-based anesthesia. American Society of Anesthesiologists website. Available at: http://www.asahq.org/For-Members/Standards-Guidelines-and-Statements.aspx. Updated October 21, 2009. Accessed January 24, 2013.
Haugh R. Competition keeps getting hotter for ambulatory surgery. Hosp Health Netw. 2006;80:68-70,72.
Horton JB, Reece EM, Broughton G 2nd, et al. Patient safety in the office-based setting. Plast Reconstr Surg. 2006;117(4):61e-80e.
Office-based surgery benefits. The Center for Menstrual Disorders and Reproductive Choice website. Available at: http://www.cmdrc.com/menstrual-disorders-a-fibroids/office-based-surgery-benefits. Accessed January 24, 2013.
Office-based surgery summary of provisions. American Society of Anesthesiologists website. Available at: http://www.asahq.org/for-members/advocacy/state-legislative-and-regulatory-issues/office-based-surgery.aspx. Accessed January 24, 2013.
Patient's checklist for office-based procedures. Institute for Safety in Office-Based Surgery website. Available at: http://isobsurgery.org/wp-content/uploads/2012/03/patient-checklist.jpg. Accessed January 24, 2013.
Safety checklist for office-based surgery. Institute for Safety in Office-Based Surgery website. Available at: http://isobsurgery.org/wp-content/uploads/2012/03/safety-checklist.jpg. Accessed January 24, 2013.
Surgical safety checklist. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what. Updated August 4, 2012. Accessed January 24, 2013.
Urman RD, Punwani N, Shapiro, F. Office-based surgical and medical procedures: Education gaps. Ochsner J. 2012;12(4):383-388.
- Reviewer: Brian Randall, MD
- Review Date: 01/2013
- Update Date: 01/24/2013