Controversy persists regarding state by state regulations of outpatient surgical facilities. Many regulations are not related to science. While well intentioned, the various qualifications of surgeons and anesthesia practitioners has lead to confusion and controversy over the safety of office-based surgery centers. Many states site complications as a numerator without a correlating denominator and qualify all surgery centers as an equivocal group despite no universality of qualifications of practitioners, anesthesia and facilities. The purpose of this study is the review the safety of outpatient aesthetic surgical procedures (underwent )at one accredited Quad A office-based outpatient surgery center by board-certified plastic surgeons with anesthesia care by board-certified anesthesiologists over a 5.5 year period.
Methods/Technique:
A retrospective review of all patients who underwent surgery at Orlando Aesthetic Institution office-based surgical facility, from 1/1/2007-8/1/2012 was performed. Patients were ASA I or II and operated on my one of four surgeons. Demographic information, including age, body mass index, gender, as well past medical history, past surgical history, tobacco and alcohol use was recorded. All cases were assessed for morbidity and mortality. Significant complications within a 30 day period of operation were included. Complication analysis included any need for re-operation, events leading to inpatient hospitalization secondary to perioperative instability or need for close monitoring.
Results/Complications:
A total of 4,548 consecutive patients underwent surgery during this study period. Almost all cases were cosmetic in nature, with a majority being multiple procedures per case. There were no deaths recorded. Total complication rate by this criteria resulted in 26 complications (0.57%). Fourteen patients (0.31%) returned to the operating room for presumptive hematoma, with one re-operation (0.02%) for incision and drainage with implant exchange for infection. Seven patients (0.15%) required transfer from this facility for inpatient evaluation of cardiac arrhythmias, respiratory insufficiency, intractable emesis, and hypotension. Within 30 days of surgery four patients (<0.01%) acquired deep vein thrombosis with no incidence pulmonary emboli.
Conclusion:
Outpatient procedures performed at an accredited Quad A office-based outpatient surgery center by board-certified plastic surgeons with board-certified anesthesiologists has been demonstrated to be safe.