How safe are office-based surgical facilities?

Like many plastic surgeons, and as my aesthetic practice has grown, I prefer to perform most surgeries in my accredited, office-based operating room. By operating in my office, I have access to my own highly qualified team members who are accustomed to working together. In this way, we can create an experience for the patient that is more private, safe, efficient, cost-effective, and highly likely to produce optimal results. Nevertheless, from time to time patients ask me how safe it is to have surgery outside a hospital environment.

There are pros and cons to operating in all types of accredited facilities. In the hospital, all medical and surgical subspecialties are readily available, should the need arise. However, undergoing elective aesthetic surgery in the hospital is often less-than-pleasant for the patient if they encounter hospital personnel who are not oriented towards creating a “concierge experience” for this type of healthy patient. Staff may resent spending their time taking care of someone who isn’t sick and they may even de-prioritize their care due to the nature of elective surgery. Patients often enjoy having their surgery in an office setting, but in the event of a severe complication, transfer to the hospital via ambulance may be necessary. Fortunately, with the advent of mandatory accreditation among board-certified plastic surgeons’ office-based surgical facilities, we now have improved standardization among these facilities, oftentimes meeting or exceeding those available in hospitals. The facility costs of surgery performed in an office-based setting are usually significantly lower than in hospitals, although this can vary by geography. Similarly, anesthesia costs are usually less in the office and patients are not subjected to out-of-network issues or paperwork.

Despite the long history of office-based aesthetic plastic surgery, until now we have lacked appropriate data to compare the safety of aesthetic surgery when done in the office versus ambulatory surgery centers or hospitals. Thankfully, data from CosmetAssure now gives us the answer. The American Association for Accreditation of Ambulatory Surgery Facilities (AAAASF) has previously published data that demonstrated the safety in office based facilities, which is affirmed by these new findings.

What is CosmetAssure?

CosmetAssure is an insurance program introduced in 2003 that offers financial coverage of unanticipated expenses related to major complications when they occur following elective cosmetic surgical procedures. Most everyone is aware that health insurance does not cover cosmetic surgery. However, many people are not aware that their health insurance may elect to not cover complications related to cosmetic surgery. CosmetAssure addresses that gap in insurance coverage for 45 days following an elective cosmetic operation. Plastic surgeons enroll patients into the program prior to their surgery. In this way, data from a large number of practices is collected prospectively in rapid fashion and every complication that occurs is also captured. Using these data, our research team at Vanderbilt University have been able to study the safety of cosmetic surgeries performed in office-based operating facilities compared with ambulatory surgery centers and hospitals.

So what did the data show? Between May 2008 and May 2013, of 183,914 total cosmetic surgery procedures performed, 70% of patients were enrolled in the CosmetAssure program. Notably, 57.4% of the procedures were performed at ambulatory surgery centers followed by 26.7% at hospitals and 15.9% in office-based surgical facilities. The utilization of hospitals decreased over the five-year period. We identified was that cosmetic surgery is very safe, no matter where it is performed, with an average complication rate of only 1.9%. Interestingly, there was a lower risk of developing a major complication in an office-based surgical facility compared with an ambulatory surgery center or hospital. This was true for complications including bleeding and infection and there was no significant difference among facilities in terms of the risk of confirmed venous thromboembolisms (VTEs).

Does this mean that office-based surgery is safe? In the hands of board-certified plastic surgeons in accredited office facilities, office-based surgical facilities are a very reasonable alternative to ambulatory surgery centers and hospitals for cosmetic procedures. Accredited offices are a safe environment for board-certified plastic surgeons to conduct single, combined, or complex cosmetic surgical procedures. Additionally, offices may have the benefit of reduced costs and better patient satisfaction without compromising safety. Safety must remain paramount in all of our minds and the facility should be chosen based upon how healthy our patients are.

Featured image credit: office by Redd Angelo. CC0 Public Domain via Unsplash.