The risk of surgical errors is no greater at outpatient surgery centers than full-service hospitals for most patients. However, certain patients may face increased risk when undergoing surgery at one of these facilities, as the case of Joan Rivers illustrates. Yesterday, I wrote about news accounts relating the cause of Joan Rivers’ death. I suspect we will be hearing a lot about her case given that she was a high profile patient who died under mysterious circumstances.
Outpatient surgery centers, also called ambulatory surgical centers, are becoming increasingly prevalent. According to the Ambulatory Surgery Center Association, 5,000-plus outpatient surgery centers performed over 23 million procedures on patients each year. The trend will continue as profiteering insurers put pressure on care providers to reduce in-hospital stays.
A recent study published in the journal Anesthesiology reported that there is “paucity of outpatient data overall” reflecting outcomes at ambulatory surgery centers. The study went on to report on 232 patients who developed major complications after outpatient surgery, including 21 who died. The study identified certain patients who carried the greatest risk: the elderly, obese patients, patients with prior cardiac surgery and patients with a history of a stroke. In healthy patients, the risk of death was minimal.
As insurers and hospitals find new ways to increase profits, the volume at outpatient surgery centers is sure to grow. The safety of these facilities should be studied in greater detail given the lack of existing studies and the serious complications reported in Anesthesiology. Only then can surgeons and anesthesiologists accurately advise patients about the risk of surgical errors, anesthesia and recovery when obtaining informed consent.