Is Office-Based Surgery Safe? Comparing Outcomes of 183,914 Aesthetic Surgical Procedures Across Different Types of Accredited Facilities

Gupta, Varun; Parikh, Rikesh T.; Nguyen, Lyly; Afshari, Ashkan; Shack, R. Bruce; Grotting, James C.; Higdon, Kent

doi:10.1093/asj/sjw138

Cited by 45 publications

(36 citation statements)

References 30 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…As a result, it makes sense that most research has been exploratory, relying on case studies of adverse events from state registries [ 4 – 10 , 29 ] or bringing together compilations of data sources [ 11 , 12 ]. The limitations of these studies have been noted in more recent research (e.g., [ 14 ]. But such studies are important first steps in determining if there is a patient safety problem that may be due to facility type or facility characteristics and, if so, what intervention research might be needed to develop evidence-based solutions.…”

Section: Discussionmentioning

confidence: 99%

The effect of facility characteristics on patient safety, patient experience, and service availability for procedures in non-hospital-affiliated outpatient settings: A systematic review

et al. 2018

View full text Add to dashboard Cite

BackgroundOver recent decades, numerous medical procedures have migrated out of hospitals and into freestanding ambulatory surgery centers (ASCs) and physician offices, with possible implications for patient outcomes. In response, states have passed regulations for office-based surgeries, private organizations have established standards for facility accreditation, and professional associations have developed clinical guidelines. While abortions have been performed in office setting for decades, states have also enacted laws requiring that facilities that perform abortions meet specific requirements. The extent to which facility requirements have an impact on patient outcomes—for any procedure—is unclear.Methods and findingsWe conducted a systematic review to examine the effect of outpatient facility type (ASC vs. office) and specific facility characteristics (e.g., facility accreditation, emergency response protocols, clinician qualifications, physical plant characteristics, other policies) on patient safety, patient experience and service availability in non-hospital-affiliated outpatient settings. To identify relevant research, we searched databases of the published academic literature (PubMed, EMBASE, Web of Science) and websites of governmental and non-governmental organizations. Two investigators reviewed 3049 abstracts and full-text articles against inclusion/exclusion criteria and assessed the quality of 22 identified articles. Most studies were hampered by methodological challenges, with 12 of 22 not meeting minimum quality criteria. Of 10 studies included in the review, most (6) examined the effect of facility type on patient safety. Existing research appears to indicate no difference in patient safety for outpatient procedures performed in ASCs vs. physician offices. Research about specific facility characteristics is insufficient to draw conclusions.ConclusionsMore and higher quality research is needed to determine if there is a public health problem to be addressed through facility regulation and, if so, which facility characteristics may result in consistent improvements to patient safety while not adversely affecting patient experience or service availability.

show abstract

Section: Discussionmentioning

confidence: 99%

The effect of facility characteristics on patient safety, patient experience, and service availability for procedures in non-hospital-affiliated outpatient settings: A systematic review

et al. 2018

View full text Add to dashboard Cite

show abstract

“…The findings were encouraging with complication rates of less than 2%, suggesting that these facilities are safe for appropriately selected patients by qualified providers. [38][39][40][41] Soltani et al, in an analysis of outcomes on all procedures performed in American Association for Accreditation of Ambulatory Surgery Facilities (AAAASF) from 2001 to 2012, showed postoperative bleeding or hematoma to be the most common complication with a hospital admission rate of 0.2%. 42 Our data supports these findings with hematoma rates of 0.6% in office-based surgical suites and 1.0% in accredited surgical centers.…”

Section: Risk Factorsmentioning

confidence: 99%

Incidence and Risk Factors for Major Hematomas in Aesthetic Surgery: Analysis of 129,007 Patients

Kaoutzanis

Winocour

Gupta

et al. 2017

Aesthetic Surgery Journal

Self Cite

View full text Add to dashboard Cite

Background: Postoperative hematomas are one of the most frequent complications following aesthetic surgery. Identifying risk factors for hematoma has been limited by underpowered studies from single institution experiences. Objectives: To examine the incidence and identify independent risk factors for postoperative hematomas following cosmetic surgery utilizing a prospective, multicenter database. Methods: A prospectively enrolled cohort of patients who underwent aesthetic surgery between 2008 and 2013 was identified from the CosmetAssure database. Primary outcome was occurrence of major hematomas requiring emergency room visit, hospital admission, or reoperation within 30 days of the index operation. Univariate and multivariate analysis was used to identify potential risk factors for hematomas including age, gender, body mass index (BMI), smoking, diabetes, type of surgical facility, procedure by body region, and combined procedures. Results: Of 129,007 patients, 1180 (0.91%) had a major hematoma. Mean age (42.0 ± 13.0 years vs 40.9 ± 13.9 years, P < 0.01) and BMI (24.5 ± 5.0 kg/m 2 vs 24.3 ± 4.6 kg/m 2 , P < 0.01) were higher in patients with hematomas. Males suffered more hematomas than females (1.4% vs 0.9%, P < 0.01). Hematoma rates were higher in patients undergoing combined procedures compared to single procedures (1.1% vs 0.8%, P < 0.01), and breast procedures compared to body/extremity or face procedures (1.0% vs 0.8% vs 0.7%, P < 0.01). On multivariate analysis, independent predictors of hematoma included age (Relative Risk [RR] 1.01), male gender (RR 1.98), the procedure being performed in a hospital setting rather than an office-based setting (RR 1.68), combined procedures (RR 1.35), and breast procedures rather than the body/extremity and face procedures (RR 1.81). Conclusions: Major hematoma is the most common complication following aesthetic surgery. Male patients and those undergoing breast or combined procedures have a significantly higher risk of developing hematomas.

show abstract

“…Gupta et al [10] reported that complication rates for office-based day surgery and procedures at ambulatory surgery centres and hospitals are 1.3%, 1.9% and 2.4%, respectively, and concluded that an accredited office-based day surgery is a safe alternative to in-hospital surgery for cosmetic procedures. They included various types of cosmetic surgeries, such as face-lift and rhinoplasty, but not mandibular contouring surgery.…”

Section: Discussionmentioning

confidence: 99%

“…Despite many risks [9] , this procedure is often performed as an office-based day surgery. Recent research showed that office-based procedures (surgical and non-surgical) doubled to approximately 10 million surgeries per year between 1995 and 2005 [10] . The safety of an office-based day surgery is still debatable.…”

Section: Introductionmentioning

confidence: 99%

In-hospital surgical treatment for haemorrhage after aesthetic mandibular osteotomy performed as an office-based day surgery: A case report

Kanke

Abe

et al. 2017

Annals of Medicine &Amp; Surgery

View full text Add to dashboard Cite

In East Asia, a square face is considered unattractive, and mandibular contouring surgery is commonly used to give a smooth contour to the lower jaw. Mandibular contouring surgery occasionally involves not only osteotomy of the mandibular angle but also resection of the masseter muscle via an intraoral approach. This type of mandibular contouring surgery poses a risk of injury to the premasseteric branch of the facial artery and massive haemorrhage.Here we report a patient who presented to our hospital with severe haemorrhage, swelling and airway constriction after bilateral mandibular angle and plane osteotomy with resection of the masseter muscle performed elsewhere as an office-based day surgery. The swelling and haemorrhage were treated successfully with emergency bilateral ligation of the facial artery and vein under general anaesthesia.We concluded that the haemorrhage was caused by rupture of the premasseteric branch of the facial artery during the resection of the masseter muscle in a day surgery.

show abstract

Is Office-Based Surgery Safe? Comparing Outcomes of 183,914 Aesthetic Surgical Procedures Across Different Types of Accredited Facilities

Abstract: Accredited OBSS appear to be a safe alternative to ASCs and hospitals for cosmetic procedures. Plastic surgeons should continue to triage their patients carefully based on other significant comorbidities that were not measured in this present study. LEVEL OF EVIDENCE 3.

Cited by 45 publications

References 30 publications

The effect of facility characteristics on patient safety, patient experience, and service availability for procedures in non-hospital-affiliated outpatient settings: A systematic review

The effect of facility characteristics on patient safety, patient experience, and service availability for procedures in non-hospital-affiliated outpatient settings: A systematic review

Incidence and Risk Factors for Major Hematomas in Aesthetic Surgery: Analysis of 129,007 Patients

In-hospital surgical treatment for haemorrhage after aesthetic mandibular osteotomy performed as an office-based day surgery: A case report

Contact Info

Product

Resources

About