| 0208-710 Coldiron
Coldiron B.
Office surgical incidents: 19 months of Florida data. Dermatol Surg. 2002 Aug;28(8):710-2; discussion 713. PMID: 12174063
brettcoldiron@hotmail.com
BACKGROUND: In 1999-2000 a series of sensational articles were published in the
lay media emphasizing the hazards of office surgery. Since then 31 state medical
boards or legislatures have, or are in the process of drafting regulations
restricting office procedures. OBJECTIVE: To determine the nature, incidence and
scope of injuries and deaths resulting from office procedures. METHODS:
Mandatory reporting by physicians to a neutral central agency of all office
surgical incidents that resulted in death, serious injury, or transfer to a
hospital in the State of Florida from February 2000 to September 2001. Telephone
and Internet follow up to determine reporting physician board status, hospital
privilege status, and office accreditation status. RESULTS: In 19 months there
were 43 procedure related-complications and eight deaths. Liposuction under
general anesthesia was the single most common cause of incidents and deaths.
There were no injuries or deaths reported with liposuction with tumescent
anesthesia. 50% of offices reporting incidents or deaths were accredited by an
independent accrediting agency. There were no incidents or deaths reported due
to the anesthesia when using conscious sedation anesthesia, or intramuscular
sedation or analgesia 98% of physicians reporting incidents or deaths had
hospital privileges and were board certified. Anesthesiologists or nurse
anesthetists provided all general anesthesia, and deep sedation. There were no
physicians performing procedures outside their scope of specialty training.
CONCLUSION: Liposuction under general anesthesia deserves closer scrutiny.
Office accreditation is not associated with fewer patient injuries and deaths.
Restrictions on tumescent liposuction, conscious sedation and intramuscular
sedation and analgesia would not yield any saved lives or fewer injuries since
these modes of anesthesia resulted in no injuries or deaths. Board certification
and hospital privilege requirements for office practice would have very little
effect since the vast majority of reporting physicians already had these
credentials. These data do not show an emergent hazard to patients from office
surgery This data strongly contradicts the lay media portrayal of the dangers of
office procedures. Mandatory reporting of office incidents should be strongly
supported, and this data should be available for analysis after protecting
patient confidentiality.
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