The chance of dying at your doctor's office is tiny, but operations at a surgery center are safer.
By LISA GREENE
Published September 9, 2003
Surgeries in doctors' offices are 10 time more likely to be fatal than those in surgery centers, according to a Florida study likely to reignite national debate about office surgeries.
Given a lack of national data on the subject, the Florida numbers should be cause for wider concern, said Arthur Levin, director of the Center for Medical Consumers, an advocacy group based in New York.
"The feeling of unease about the state, whether Florida or New York, having so little control over what goes on in the private doctor's office is justified," said Levin.
In the new study, researchers reviewed reports of 182 incidents of injuries, including 13 deaths, during office surgeries in Florida from April 2000 to April 2002.
The 13 deaths cited in the new study include five heart attacks during various procedures, including a colonoscopy and a tummy tuck; two people who died of blood clots in the lungs after liposuction with tummy tucks; and two people who bled to death, one after a tonsillectomy and one after a liver biopsy.
The chances of dying in an office surgery were tiny: 9.2 deaths per 100,000 operations. But researchers found a much smaller death risk, 0.78 per 100,000 operations, at surgery centers.
The numbers suggest that state medical boards should regulate office surgeries more closely, said Levin, the consumer advocate.
The national Federation of State Medical Boards has done as much.
The group appointed a special committee in 2001 to study the issue and recommend guidelines for state regulation of office surgeries, which have not had the same scrutiny as those performed in hospitals and surgery centers.
"It's clear there may be more damage going on in offices than we've been aware of," Dr. James Thompson, president and CEO of the federation, said of the new study.
Florida already has tighter rules than most other states.
In 2000, the state placed a three-month moratorium on some types of office surgeries because of safety concerns. New rules limited the types of procedures, set credentials for surgeons and required that doctors' offices have accreditation from a national group.
Rules have tightened further since the study ended in April 2002. More doctors' offices have accreditation now, and the state requires an anesthesiologist when a patient is put to sleep.
That means conditions in Florida may already be safer, said Dr. Hector Vila Jr., lead author of the study, published in the September issue of Archives of Surgery.
"The message to the citizens of Florida is, things were bad, changes are getting made, things are getting better," said Vila, chief of anesthesiology at H. Lee Moffitt Cancer Center & Research Institute in Tampa.
Office surgeries have become popular as more surgeries have moved from the hospital bed to outpatient procedures. The trend has been prompted by efforts to cut health care costs, combined with advances in technology and anesthesia, said the medical boards federation.
In the 1970s, more than 90 percent of surgeries were performed in hospitals. Now, about 65 percent of surgeries are outpatient procedures, and the proportion of those performed in doctors' office is on the rise.
Surgeries in doctors' offices often include biopsies, endoscopies and liposuction and other cosmetic procedures.
Officials with the Florida Board of Medicine are continuing to review the safety of office surgery, said Maureen Doherty, spokeswoman for the board.
"It's an ongoing process," she said. "They're continuing to look at it to improve the welfare of the citizens of Florida."
Statistics on the number of deaths since April 2002 weren't immediately available Monday, though Vila said Monday they have declined.
Frank Mirabella, who represents the Florida Academy of Cosmetic Surgeons, said the study's results aren't reliable because Vila is an anesthesiologist who benefited from rules requiring his services.
"That's the kind of spin they want to put on it," Mirabella said.
The 200 cosmetic surgeons in the academy have never had a patient die from an office surgery, Mirabella said.
But even Vila said he wouldn't rule out office surgeries and thinks the practice is likely to increase.
"Surgeons like it because they have more control," he said. "Patients like it because it's more user-friendly. ... As long as it can be done safely, I think it can be a good thing."
Increased regulation of office practices is likely to happen as well, said Thompson, the boards federation president.
"You're going to see a demand placed by the public on office-based surgery centers being fully accredited," he said.
The other authors of the study are Dr. Roy Soto of the University of South Florida College of Medicine; Alan B. Cantor of Moffitt; and Dr. David Mackey of the University of Florida College of Medicine.
Questions to ask
Patients considering office surgeries are urged to ask several questions:
Is the facility accredited?
Who gives sedation?
Does the surgeon have hospital privileges for the same surgery?
Where are patients taken in emergencies?
- Source: Dr. Hector Vila Jr., chief of anesthesiology, H. Lee Moffitt Cancer Center and Research Institute.
