Efficacy, Safety, and Cost of Office-Based Surgery

Abstract

An increasing number of media reports on patient safety risks arising from office-based surgery procedures, as well as growing concerns about patient safety issues in general, have brought office-based surgery as well as its practitioners into focus and placed this very cost-effective medical practice in the eye of the media and regulators. Concerted efforts are now being made to understand the causes and true incidence of patient safety risk associated with office-based surgery and to find ways to minimize this risk.

Preoperative Expectations and Values of Patients Undergoing Mohs Micrographic Surgery

“…Improving patients' satisfaction by meeting their expectations is an important compass to guide health care delivery 29–36 . MMS has been demonstrated to offer the highest cure rate for skin cancers, minimal morbidity, superior cost‐effectiveness, and tissue‐sparing tumor removal to facilitate simpler reconstruction 5–27 . Although these characteristics of MMS are important to dermatologists, there has been a paucity of literature assessing how patients view the value of MMS.…”

“…Although procedures performed under conscious sedation or general anesthesia have greater morbidity and mortality, our participants, as a whole, placed a low value on avoiding general anesthesia 19 . From a clinical standpoint, the lower morbidity and mortality in procedures that use local anesthesia cannot be understated 15–18,44–48 . Although risks commonly associated with general anesthesia such as aspiration are well documented in the medical literature, the participant population did not value avoiding these risks 15,17–19 .…”

“…From a clinical standpoint, the lower morbidity and mortality in procedures that use local anesthesia cannot be understated 15–18,44–48 . Although risks commonly associated with general anesthesia such as aspiration are well documented in the medical literature, the participant population did not value avoiding these risks 15,17–19 . Lack of patient awareness is one possible explanation, so it is important to educate new patients regarding the excellent pain control and safety profile of local anesthesia.…”

“…MMS is almost universally performed in an office‐based setting using local anesthesia, avoiding the morbidity and expense of surgery in the operating room. Previous studies have documented the safety of office‐based procedures and MMS 15–19 . Moreover, MMS has been shown to be cost‐effective and tissue sparing 20–27 .…”

Why Are There Differences in the Perceived Safety of Office-Based Surgery?

“…In January 2002, a National Institute of Health‐funded conference discussed the efficacy, safety, and cost of office‐based surgery from a multidisciplinary perspective. Data presented by researchers and practitioners from specialties such as anesthesiology, dermatology, plastic surgery, and ophthalmology demonstrate a very low incidence of adverse events resulting from office‐based surgery 7 …”