Safety and Efficacy of Office-Based Surgery with Monitored Anesthesia Care/Sedation in 4778 Consecutive Plastic Surgery Procedures

Abstract

Office-based surgery has several potential benefits over hospital-based surgery, including cost containment, ease of scheduling, and convenience to both patients and surgeons. Scrutiny of office-based surgery by regulators and state-licensing agencies has increased and must be addressed by improved documentation of safety and efficacy. To evaluate the safety and efficacy of the authors' office-based plastic surgery, a review was undertaken of 3615 consecutive patients undergoing 4778 outpatient plastic surgery procedures under monitored anesthesia care/sedation in a single office. The charts of 3615 consecutive patients who had undergone office-based surgery with monitored anesthesia care/sedation between May of 1995 and May of 2000 were reviewed. In all cases, the anesthesia protocol used included sedation with midazolam, propofol, and a narcotic administered by a board-certified registered nurse anesthetist with local anesthesia provided by the surgeon. Charts were reviewed for patient profile, types of procedures, multiple procedures, duration of anesthesia, American Society of Anesthesiologists class, and complications related to anesthesia. Outcomes measured included death, airway compromise, dyspnea, hypotension, venous thrombosis, pulmonary emboli, protracted nausea and vomiting lasting more than 24 hours, and unplanned hospital admissions. Statistical analyses were performed using the Microsoft Excel program and the SAS package. Results were as follows: 92.3 percent of the patients were female and 7.7 percent were male, with a mean age of 42.7 years (range, 3 to 83 years). Patients underwent aesthetic (95.6 percent) and reconstructive (4.4 percent) plastic surgery procedures. Same-session multiple procedures occurred in 24.8 percent of patients. The vast majority of patients were healthy: 84.3 percent of patients were American Society of Anesthesiologists class I, 15.6 percent were class II, and 0.1 percent were class III. The operations required a mean of 111 minutes. There were no deaths, ventilator requirements, deep venous thromboses, or pulmonary emboli. Complications were as follows: 0.05 percent (n = 2) of patients had dyspnea that resolved, 0.2 percent (n = 6) of patients had protracted nausea and vomiting, and 0.05 percent (n = 2) of patients had unplanned hospital admissions (<24 hours). One patient had an emergent intubation. No prolonged adverse effects were noted. There was a 30-day follow-up minimum. Outpatient surgery is an important aspect of plastic surgery. It was shown that office-based surgery with intravenous sedation, performed by board-certified plastic surgeons and nurse anesthetists, is safe. Appropriate accreditation, safe anesthesia protocols, and proper patient selection constitute the basis for safe and efficacious office-based outpatient plastic surgery.

Colonoscopy in the Office Setting is Safe, and Financially Sound … For Now

“…Although there is ample evidence of the safety of ASCs, 2 there is little information in the literature regarding office procedures, especially endoscopy. Although there have been reports of large series of surgical procedures performed under general anesthesia or monitored anesthesia care at single institutions with enviable safety records, 3,4 there is little in the way of systematic reporting of outcomes of office-based surgery. In one of the few reports of its kind, Vila et al 5 used a state-wide registry mandated by the state of Florida to compare office-based procedures to procedures performed in ASCs.…”

Patient safety

“…9 A retrospective study including 5316 plastic surgery patients cited a complication rate of 0.7%. 15 In another study of 23,000 consecutive procedures under general anesthesia, there were no deaths and no significant complications. 16 A smaller prospective study among older patients noted a complication rate of 1.5 %.…”

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.…”