Office-based surgery? Advantages, disadvantages, and the nurse's role

Headnote

Office-based surgery is a growing trend in surgical services offered to many patients, however, it is not without risk. In knowing the facts about office-based surgery, nurses will be able to assist our patients in the most appropriate decisions regarding their surgical care. This article will present the indications. advantages, and limitations of office-based surgery, as well as the nurse's role in this environment.

n recent years office-based surgery has become the norm for many surgeons. According to the American Society for Plastic Surgeons, approximately 48% of their physician members have outpatient surgical facilities (Morello, Colon, Fredericks, & Iverson, 1997). While office-based surgery is a growing trend in surgical services offered to many patients, it is not without risk. In August of 2000, a 90-day moratorium was placed on office-based surgery in Florida for offices using level III anesthesia, as well as intravenous sedation beyond that of level II (conscious sedation). This dramatic measure was in response to an unusually high morbidity and mortality rate. Four deaths were in women undergoing cosmetic surgery. T\vo of the deaths appeared to be anesthesia related and two were from pulmonary embolus following abdominoplasties. Although the ban was lifted by November, a safety panel was created to collect information regarding the complications, and make recommendations to improve safety. In knowing the facts about office-based surgery, hopefully we, as nurses, will be able to assist our patients in the most appropriate decisions regarding their surgical care. This article will present the indications, advantages, and limitations of office-based surgery.

Advantages

There are several advantages to both the patient and the physician. First, and probably most obvious, is cost containment, because the cost to the patient is often lower. For example, a facility fee is set for a patient having cosmetic surgery. Then the patient can be made aware of their financial responsibility prior to their surgery. If the surgery is medically necessary, and The American Association of Accreditation of Ambulatory Surgery Facilities (AAASF) accredits the facility, fees may be reimbursable by the patient's insurance. Insurance coverage opens the door for an increase in the number of and interest in office-based surgeries.

A second advantage is the excellent safety record in office-based settings. In 1997, Morello and colleagues (1999) published the...