Analysis of Outpatient Surgery Center Safety Using an Internet-Based Quality Improvement and Peer Review Program

Abstract

Assessing the quality of care delivered in office-based outpatient surgery centers is difficult because formerly there was no central data collection system. The American Association for Accreditation of Ambulatory Surgery Facilities (AAAASF), in its ongoing effort to assess and improve patient care, has developed an Internet-based quality improvement and peer review program to analyze outcomes for surgery centers it accredits. Reporting is mandatory for all surgeons operating in AAAASF-accredited facilities. Each surgeon must report all unanticipated sequelae and at least six random cases reviewed by an accepted peer review group biannually. A total of 411,670 procedures were analyzed during a 2-year period (from 2001 to 2002). There were 2597 sequelae reported during this period. The most common sequela was hematoma formation following breast augmentation. Infection occurred in 388 cases. Deep vein thrombosis, pulmonary embolism, and intraoperative cardiac arrhythmias were found to occur in a frequency consistent with previous reports. Significant complications (hematoma, hypertensive episode, wound infection, sepsis, and hypotension) were infrequent. A total of 1378 significant sequelae were reported for 411,670 procedures. This calculates to one unanticipated sequela in 299 procedures (an incidence of 0.33 percent). Seven deaths were reported. A death occurred in one in 58,810 procedures (0.0017 percent). The overall risk of death was comparable whether the procedure was performed in an AAAASF-accredited office surgery facility or a hospital surgery facility. This study documents an excellent safety record for surgical procedures performed in accredited office surgery facilities by board-certified surgeons.

Incidence and Risk Factors for Major Hematomas in Aesthetic Surgery: Analysis of 129,007 Patients

“…The findings were encouraging with complication rates of less than 2%, suggesting that these facilities are safe for appropriately selected patients by qualified providers. [38][39][40][41] Soltani et al, in an analysis of outcomes on all procedures performed in American Association for Accreditation of Ambulatory Surgery Facilities (AAAASF) from 2001 to 2012, showed postoperative bleeding or hematoma to be the most common complication with a hospital admission rate of 0.2%. 42 Our data supports these findings with hematoma rates of 0.6% in office-based surgical suites and 1.0% in accredited surgical centers.…”

Patient safety in dermatologic surgery

“…Data from large studies on officebased surgery were able to quell some of the regulatory uncertainty and fear of widespread harm, noting complication rates of 0.3% to 1.5%. [6][7][8][9][10] Reported complication rates of ambulatory or office-based surgery often relate to the use of general anesthesia. Dermatologic surgery is generally performed using local or regional anesthesiasometimes including mild sedation-and therefore the inherent risk is minimized to an even greater degree.…”

Certificate-of-Need Regulation in Outpatient Surgery and Specialty Care: Implications for Plastic Surgeons

“…28 -30 A recent study suggested that patient safety in outpatient surgery is highly correlated with American Association for Accreditation of Ambulatory Surgery Facilities certification and board certification of the operating surgeon. 31 Although several states do not require accreditation, the American Society of Plastic Surgeons and the American Society for Aesthetic Plastic Surgery recognize the importance of performing surgery in an accredited or state-licensed facility through a joint mandate of their members. 32 Professional self-regulation, such as the American Society of Plastic Surgeons Task Force on Patient Safety, may prove to be the most efficacious method of ensuring safety in outpatient or office-based surgery.…”