Efficacy, Safety, and Cost of Office-Based Surgery: A Multidisciplinary Perspective

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.

The use of botulinum toxin as primary or adjunctive treatment for post acne and traumatic scarring

“…These include strabismus, nystagmus, achalasia, anal fissue, dystonias including cerebral palsy, torticollis, dysphonia, blepharospasm, hemifacial spasm[12] and hyperhidrosis. [3] Botulinum toxin now also has a long and stable history in the treatment of facial hyperkinetic lines. [4–8]…”

Promoting a Culture of Patient Safety

“…4 The actual number of operations performed in the office-setting is not known, but based on the data, it appears that the risk of mortality associated with office surgery is very low 4 and compares favorably with data presented by researchers and practitioners across various specialties demonstrating a very low incidence of adverse events resulting from office-based surgery. 1 The surgeon must consider the risk factors associated with certain procedures when deciding whether such procedures should be performed in an accredited office-based surgical facility, outpatient surgery center, or hospital-based facility.…”

“…1 Since the release of the Institute of Medicine's 2 (IOM) report To Err Is Human, significant progress has been made in patient safety. According to the IOM's report in 2000, between 48,000 and 98,000 annual U.S. hospital deaths result from medical errors.…”

“…3 Although there has been considerable media controversy regarding reports of decreased patient safety and errors that have occurred in operating rooms of hospitals, ambulatory surgery centers (ASC), and doctors' offices, the majority of data across various specialties demonstrate a very low incidence of adverse events resulting from office-based surgery. 1 Improving patient safety should be among the highest priorities of health care leaders and managers.…”

A randomized, double-blind comparison of the total dose of 1.0% lidocaine with 1:100,000 epinephrine versus 0.5% lidocaine with 1:200,000 epinephrine required for effective local anesthesia during Mohs micrographic surgery for skin cancers

“…3 Local anesthesia enables skin cancer surgery to be performed in an office-based setting and offers patients improved convenience, decreased cost, and a better safety profile compared with general anesthesia and intravenous sedation. [3][4][5][6] Most physicians choose lidocaine as the preferred agent for local anesthesia because of its quick onset, favorable duration of action, and excellent safety profile. 5,7 Although toxicity from lidocaine is rare, 4,8 excessive doses of lidocaine affect the central nervous and cardiovascular systems in a predictable and dose-dependent manner.…”