Office-Based Surgery and Anesthesia

Advances in technology and anesthesia now allow invasive procedures once done only in hospitals or ambulatory surgical centers to be performed in physician offices. The trend toward office-based surgery is evident in numerous specialties: otolaryngology, ophthalmology, gynecology, dermatology, general surgery, gastroenterology, oral surgery, podiatry, and plastic surgery, among others. Colonoscopy, endoscopy, knee arthroscopy, pregnancy termination, microlaparoscopy, transvaginal retrieval of oocytes for in vitro fertilization, breast augmentation and reduction, abdominoplasty, liposuction, and other cosmetic plastic surgeries are examples of some of the procedures commonly performed in physician offices. Some of these procedures require sedation or general anesthesia. It is estimated that out of 80 million outpatient surgeries performed in 2009, more than 12 million (15%) were performed in a doctor’s office (Midey).

However, research regarding patient safety in an ambulatory setting is still limited. A review conducted by the American Medical Association concluded that, though office-based surgery has been a focus of some such studies in recent years, little is yet known regarding how to improve patient safety in an ambulatory setting, partially due to the unique nature of each practice setting. (Latner)

All operative or invasive procedures, particularly those that use sedation or anesthetic agents, carry inherent risk. This Risk Analysis examines regulations, standards, and guidelines promulgated by states, state boards, accrediting agencies, and professional associations and presents examples of cases in the courts and in the media that demonstrate the importance of creating strategies to mitigate risk in the office when it comes to providing surgical services.

Key factors are the importance of appropriate accreditation and licensure for both the facility and the staff. Not all states regulate office-based surgery centers or procedures, so organization leadership must be extraordinarily vigilant in maintaining the highest levels of patient safety. Accreditation by a national organization, covered in the discussion Regulation and Accreditation, is a valuable step toward demonstrating competency in the surgeries to...