Office Based Surgeries
Though the vast numbers of plastic surgery operations within the U.S. are conducted without complications, experts argue there is a need for universal regulations when it comes to office-based practices.
Most ambulatory surgery facilities are unaccredited, operating independent of any peer review and inspection process. Furthermore, most states will allow a doctor without surgical training to legally perform surgery in an unaccredited office-based facility, independent of peer review and inspection.
Leida Snow, American Society for Aesthetic Plastic Surgery (ASAPS) senior communications officer, has expressed concern that this phenomenon has been permitted to continue. "Eventually, one hopes there will be a national standard in terms of accreditation," said Snow. "There are patients that will walk into these facilities and allow anyone with an MD after his name to wield a scalpel on them."
As an ASAPS report notes, California, Florida, Georgia, New Jersey and Texas are the only states that mandate accreditation for all outpatient surgical facilities that administer sedation or general anesthesia. While there are other states that may soon follow suit, the large majority of states have not pushed the agenda as much as many within the plastic surgery domain would like to see.
Published data confirms that the rate of complications for plastic surgery performed by American Board of Plastic Surgery certified surgeons in accredited office-based facilities was less than half of one percent (0.47 percent) in over 400,000 operations, a safety record comparable to hospital surgery.
"Back in the old days, most surgery was done in hospitals," said Dr. Walter Erhardt, who conducts his plastic surgery practice at the Putny Phoebe Memorial Hospital in Albany, Georgia. "Then there was a big push to do surgery in out-patient centers. This was done to reduce costs."
Dr. Devinder Mangat, president of the American Academy of Facial Plastic and Reconstructive Surgery, says the safety and welfare of the patient is the fundamental reason behind accreditation. "When surgery is going to be performed out of the hospital setting, the Academy recommends that its members do so in a facility that has been accredited by the Accreditation Association for Ambulatory HealthCare (AAAHC)...or an equivalent accrediting body," said Mangat. "Accreditation assures the proper level of professional achievement and a high level of quality of care. Operating in an accredited facility shows that the surgeon and his facility have demonstrated their commitment by measuring up to the highest standards." According to the ASAPS, there were over 4.6 million cosmetic surgical and non-surgical procedures performed in 1999. This figure represents a 66 percent increase in the total number of procedures performed between 1998 and 1999. Furthermore, in 1999, 89 percent of cosmetic procedures were performed on females (compared to 90 percent in 1998) and 11 percent on males (compared to 10 percent in 1998).
The popularity of plastic surgery procedures is one reason for the increased call for a national initiative to force all practices to comply with the call for accreditation. Advantages of office-based surgery include greater privacy and convenience, more personalized attention, and avoidance of possible exposure to hospital-based infectious agents. While costs are sometimes lower, high quality care should be the determining factor in choice of facility.
"As long as the facility where the surgery is being performed is accredited, the patient is at no greater risk than he would be if the same surgery is performed in the hospital as long as the appropriate surgical and anesthesia team members are present," said Mangat. "The Academy, as a matter of fact, requires all fellowship directors to operate in accredited facilities only."
Snow says patients, too, need to take the initiative by asking questions of the surgeons they are considering. "The most important thing is to educate the public," said Snow. "Surgery is a serious decision."
Erhardt agrees that the public needs to be more discerning about where they take their business. "It strikes me that people are more careful in selecting a hairdresser than finding a surgeon," he said. "Patients don't really think about that. The regulations and the state agencies have not kept up with the trend."