Doctor's-Office Surgery 12 Times Riskier
Much Higher Death, Injury Rates When Doctors Perform Surgery During Office Visits
Sept. 8, 2003 -- In-office surgery is fast. It's convenient. It's cheaper. And it's 12 times more likely to kill or injure you.
Nobody likes to go to the hospital. That's especially true for surgeries that don't really require a hospital stay -- things like colonoscopy, tonsil removal, or liposuction. You could go to an ambulatory care center. These freestanding surgical centers are convenient and handle more than half of all surgeries.
But recently, lots of doctors are offering an even more convenient option. They'll do the surgery during an office visit. Some 1.2 million patients chose this option each year. But there's a difference. Ambulatory care centers -- and the doctors and nurses who work in them -- have to be licensed. Doctors' offices don't.
Does all this regulation really matter? Hector Vila Jr., MD, chief of anesthesia at the H. Lee Moffitt Cancer Center in Tampa, Fla., and colleagues decided to find out.
"We looked at patient outcomes from office surgeries and compared them to outcomes from ambulatory care centers," Vila tells WebMD. "If there was no difference in outcomes, one could argue that many of those regulations that ambulatory surgical centers labor under are unnecessary."
What Vila's team found makes the regulations look like a lifeline. Patients died nearly 12 times more often in surgery during office visits. They also suffered injuries 12 times more often. The report appears in the September issue of Archives of Surgery.
The findings are surprising -- even to experts who understand the issue. In 2002, the Federation of State Medical Boards (FSMB) issued guidelines for regulating office-based surgery. James N. Thompson, MD, is president and CEO of the FSMB.
"I'm a little surprised at the breadth of the variation in complications between ambulatory surgical centers and office surgeries," Thompson tells WebMD. "This is a relatively small survey. But it points to the need for more data."
There isn't much more data out there. What made this study possible was that Florida in March 2000 became the first state to require doctors to report things that went wrong during office surgeries. Only 10 states regulate office-based surgery, and only a few require any reporting of injuries or deaths during these operations.
That's too bad. Because if what Vila found in Florida holds true for the rest of the U.S., there are some 96 extra deaths every year.
Many Doctors' Offices Unsafe
What's going wrong? Vila points to three areas. The first is doctor accreditation. A lot of the deaths and injuries happened when surgery during office visits was performed by doctors who weren't board certified.
"Maybe a doctor goes to take a weekend course in colonoscopy and decides it's a lucrative business," Vila says. "He does not go to work at an ambulatory care center. They would require credentials he doesn't have. But he could open an office and do those procedures -- and that did account for some of the deaths in our study. Doctors who couldn't get privileges anywhere else were doing surgery in their offices."