Doctor's-Office Surgery 12 Times Riskier
Much Higher Death, Injury Rates When Doctors Perform Surgery During Office Visits
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."
The second problem is the office itself. Doctors' offices don't need hospital accreditation. And some aren't up to snuff.
"In ambulatory surgery centers there are lots of facility requirements," Vila says. "None of that exists in an office, where a doctor is a sort of one-man shop. You need accreditation of the facility. We found that many of the deaths occurred in unaccredited offices. Only 38% of the facilities were accredited where deaths occurred. Whereas 100% of ambulatory surgical centers are accredited."
And the third problem is anesthesia -- and the people who watch over it in doctors' offices. Only 15% of the doctors' office deaths occurred in offices that used an anesthesiologist.
"Sometimes the physician will delegate anesthesia to a nurse," Vila says. "In some deaths, this was delegated not even to a registered but often to a licensed practical nurse or even an office assistant."
What You Can Do
It's not always easy to tell whether surgeons -- and their offices -- are following the best safety standards. Vila and Thompson strongly urge patients to ask several hard questions:
- Ask about the qualifications of the surgeon. Ask: Are you board certified? Do you have privileges to do this at a hospital? "To get those privileges, a surgeon has to undergo review by his or her peers," Vila says.
- Ask about the facility. The main question: Is this facility accredited? There are four or five national accrediting bodies, so it's hard to judge whether one accreditation is better than another. But a yes-or-no answer gives a lot of information here.
- Ask about anesthesia and who is in charge of it. Ask: Who is going to do my anesthesia? "Look for an answer that it is someone, either an anesthesiologist or a nurse anesthetist, who is well trained and has privileges at a local hospital," Vila urges. "If it is someone who has lost hospital privileges, ask whether this person has credentials someplace. So a good answer would be: "I will be ordering the anesthesia and we have a nurse that has done anesthesia for years and has advanced training."
- Ask about emergency plans. "I'd want to know what facilities are available for transfer if there are complications," Thompson says.
- Ask about the surgeons' reputation. "I would ask among friends or other doctors as to the surgeon's reputation and outcomes," Thompson recommends.
- Check out the surgeon. "I would check with state licensing authorities to see if disciplinary actions have been filed against the individual. This is freely available to the public," Thompson says. "And 60% of docs have licenses in more than one state, so the relevant information might not be on your state's record. So check with the FSMB."