MONDAY, Sept. 8, 2003 (HealthDayNews) -- Patients need to carefully consider the risks when deciding to have minor surgery in a doctor's office instead of in an ambulatory surgery center, a new study suggests.
"Our research compared adverse outcomes and deaths in physicians' offices with those in ambulatory surgical centers," explains study author Dr. Hector Vila Jr., an assistant professor of oncology and anesthesiology at the H. Lee Moffitt Cancer Center in Tampa, Fla.
"We found a much higher death rate and a much higher injury rate when surgery was done in the physician's office," he adds.
Vila and his team looked at all the incidents of death and injury during surgery in doctor's offices, reported to the Florida Board of Medicine from 2000 through 2002. They also looked at similar data from ambulatory surgical centers during 2000, reported to the Florida Agency for Health Care Administration.
They found the rate at which injury occurred in doctor's offices was 66 per 100,000 operations, compared with five per 100,000 surgeries in ambulatory surgical centers. For death, the corresponding numbers were nine per 100,000 in doctor's offices and less than one per 100,000 in ambulatory surgical centers.
The researchers note that if all procedures had been done in surgical centers, about 43 injuries and six deaths would have been prevented each year. These findings appear in the September issue of the Archives of Surgery.
According to Vila, the procedures they looked at included all types of outpatient surgeries. Most surgeries were plastic surgeries and endoscopies, a procedure using a fiber optic scope to look at the intestinal tract, he says.
Vila believes this problem is not confined to Florida.
There are many reasons for this dramatic difference, Vila says. They include lack of equipment and personnel, lack of set procedures, and the inability to deal with emergencies. "Sometimes it's the credentials of the people performing the procedure or administering the anesthesia," Vila adds.
"If you go to work in a hospital, as a physician you have to apply for privileges, but as a private physician you can do whatever you want in your office," Vila says. "You don't have to show to anyone that you are able to do the procedure. You just open your office and do it."
Vila believes this is a new problem in medicine, and it comes down to money. Office surgeries are much cheaper than those done in ambulatory surgery centers.
In addition, "physicians who can't get privileges in a hospital, because they are not board-certified or don't have the credentials to do the procedure, do it in their office because it's the only place they can do it," Vila says.
Patients concerned with safety need to ask several questions before deciding to have surgery in their doctor's office, Vila advises.
"You should ask if your doctor has the same standards as those used in the hospital or ambulatory surgical center. Are the physicians board-certified to do the procedure? Do they have the same equipment? Do they have emergency resuscitative equipment? Who is going to be giving the anesthesia? And, where will you be taken if there is an emergency?"
"If you are unsure, then you should consider having your surgery in an ambulatory surgical center," Vila says.
Dr. Jeffery Salomon, an assistant professor of plastic surgery at Yale University School of Medicine, says the way Vila collected the data may not justify his conclusions. Salomon does not doubt that the problem exists, but because the data in the study does not compare identical groups of patients, the conclusions may not be accurate.
Salomon also says many of the problems in office surgery appear related to not having anesthesia administered by an anesthesiologist. In his own practice, Salomon will do office procedures only when a local anesthetic is needed. If patients need to be sedated, then he does the procedure in a surgery center.
"It's not worth the risk," Salomon says. "It's the difference between flying a no frills commuter airline or flying first class on a major airline," he adds.
For Salomon too, it all comes down to money. "If surgery in outpatient surgery centers were affordable, then you wouldn't be having all these office surgeries," he says. "A lot of people can't afford to have their surgery in ambulatory surgical centers; it's just too expensive. And a lot of the problem is greed on the part of the doctors, who want to do procedures they are not qualified to do."
More information
To learn more about surgery, visit the American College of Surgery or the American Society of Plastic Surgeons.
