As state medical boards and legislatures propose regulations to restrict surgeries performed in physicians’ offices, two new studies report such action would have little impact on the overall patient safety of medically necessary procedures.
In a study released today in the December issue of Dermatologic Surgery, the journal of the American Society for Dermatologic Surgery, patients who undergo cosmetic procedures under general anesthesia are at a higher risk of complication and death than those who had procedures performed with local anesthesia.
The greatest danger seems to lie not with surgical procedures in office settings per se, but with certain cosmetic procedures that are performed in office settings, particularly when under general anesthesia, said lead author and dermasurgeon Brett Coldiron, MD, clinical assistant professor, department of dermatology and otolaryngology, University of Cincinnati College of Medicine.
In one of the articles, Coldiron and colleagues analyzed three years of data reported in Florida, the state with the highest reporting of adverse incidents from in-office surgical procedures.
Restrictions, such as more stringent credentialing to require hospital privileges, for medically necessary in-office surgery using local anesthesia or intravenous sedation techniques would have little beneficial safety impact and could potentially limit patients? access to necessary medical care, stressed Coldiron. He added that the new research should be comforting to patients who need medically necessary surgery, such as Mohs procedures to excise skin cancers, since most complications occur from invasive plastic surgeries that require general anesthesia.
He further explained that even though plastic surgeons and dermatologic surgeons both perform liposuction, dermasurgeons use tumescent or local anesthesia for this procedure and therefore patients rarely, if ever, develop blood clots, which can occur when liposuction is performed under general anesthesia.
We found that physicians operating with general anesthesia tend to do multiple procedures at the same time, which causes a greater risk to the patient because the patient stays under general anesthesia for longer period of time, said Coldiron. In fact, the Florida medical board has put a restriction on multiple procedures, particularly not allowing abdominoplasty and liposuction to be performed at the same time under intravenous sedation or general anesthesia. Dr. Coldiron notes that since Florida put the restriction in place, there have been no deaths due to liposuction in an office setting.
Dermatologists are generally risk-averse and prefer the unprecedented safety profile of liposuction using tumescent local anesthesia, said C. William Hanke, a dermasurgeon in Carmel, Ind., in a commentary that accompanied the articles. He added that published studies by the Wake Forest group and others have yet to report a fatality from liposuction when properly performed under tumescent local anesthesia.
Office-based surgery is safe and effective when performed by a properly trained physician with the appropriate procedure and level of anesthesia, said Gary Monheit, MD, President-Elect of the American Society for Dermatologic Surgery (ASDS), associate professor, Department of Dermatology and Ophthalmology at the University of Alabama at Birmingham, Ala. The real concern is that patients who undergo cosmetic procedures are often unaware of all the risks involved, including where to have the surgery and which types of anesthesia are available.
In fact, a new survey conducted by the ASDS and Harris Interactive shows that 61 percent of women surveyed between the ages of ages 30 to 50 years of age think that liposuction is safer if performed in a hospital setting.
It is this lack of knowledge among consumers about their options that concerns the ASDS. For example, Dr. Monheit says that many consumers don?t know that liposuction is a procedure that can now be done safely in a physician?s office using a diluted local anesthesia called tumescent anesthesia.
However, many patients and physicians do see the benefits of having cosmetic surgeries performed in an office because it is more convenient, avoids infections that can occur in hospitals, eliminates some of the complications of surgery due to general anesthesia normally used in hospital operating rooms, and costs 60 to 70 percent less than hospital surgeries because of hospital operating rooms and the staff needed to run them generate costly overhead.
The ASDS urges consumers to check a practitioner?s qualifications and credentials before undergoing any procedure to avoid the risk of complications from substandard treatment, and suggests consumers ask their physician?s and themselves the following questions:
Why is this the right procedure for me?
What kind of anesthesia can be used for this procedure? Where is the best location for this procedure?
What are the short- and long-term risks of this procedure and are there additional risks to doing multiple procedures in one surgery?
Is my doctor properly credentialed and board certified in dermatology or another specialty with equivalent training and experience?
Does my doctor answer my questions no matter how minor?