Office surgery safety and the Florida moratoria.
BACKGROUND
Office-based surgery has become an important method of healthcare delivery, but there is controversy about its safety. Since 2000, a series of articles were published in the lay media emphasizing the hazards of office surgery, leading to the Florida Board of Medicine restricting office procedures.


OBJECTIVE
The objective of this study was to determine the nature and scope of deaths resulting from office surgery.


METHODS
We reviewed the data on mandatory reporting by physicians to a central agency of all office surgical incidents that resulted in death, injury, or hospital transfer in the state of Florida from January 2000 to November 2004. E-mail, Internet, and telephone follow up were used to determine physician's board status, office accreditation, and hospital privileges. We reviewed data on medication interactions, anesthesia, and monitoring.


RESULTS
A total of 36 deaths related to office procedures were reported. Only 18 of those were related to surgical procedures that are within the realm of plastic surgery, although surgeons of other specialties did 3 of these. When these 18 were reviewed by type of anesthesia, there were 12 who had general anesthesia, 10 with an anesthesiologist and 2 with a Certified Registered Nurse Anesthetist. Of those 18, 7 died before discharge. Although all 7 of them survived long enough to be transferred to a hospital, we classified them as office deaths. The other 11 died after appropriate discharge. Of the 7 office deaths, one developed bronchospasm during induction by an anesthesiologist. Five were during deep sedation (level III anesthesia) and 4 appeared to be related to excessive sedation and/or inadequate monitoring; the fifth was probably related to illicit drug use and the sixth from a fat embolism. Of the 11 postoperative deaths, 7 were said to be the result of thromboembolism and the others were from unknown causes.


CONCLUSIONS
Although the total number of office operations during the study period is unknown, the fact that 7 deaths were reported would suggest that the location in which these procedures were done was not as much of a factor as the regulators have suggested. However, better patient screening, sedation management, deep vein thrombosis prophylaxis, and clinical judgment may have prevented some, if not most, of these deaths. The most frequent cause of death after discharge was thromboembolism, and some of these might have been prevented with better prophylaxis. More detailed findings and recommendations are presented.
Clayman
Mark A
MA
Department of Surgery, Division of Plastic & Reconstructive Surgery, University of Florida Health Science Center, Gainesville, Florida 32610, USA. mclayman@ufl.edu
Caffee
Hollis H
HH
D000328:Adult; D000556:Ambulatory Surgical Procedures / Q000009:adverse effects* / Q000331:legislation & jurisprudence*; D002423:Cause of Death; D016292:Procedural Sedation / Q000009:adverse effects; D003625:Data Collection; D005161:Facility Regulation and Control / Q000331:legislation & jurisprudence*; D005260:Female; D005431:Florida / Q000453:epidemiology; D006801:Humans; D015187:Lipectomy / Q000401:mortality*; D016343:Monitoring, Intraoperative; D010824:Physicians' Offices / Q000706:statistics & numerical data; D012307:Risk Factors; D013518:Surgery, Plastic / Q000331:legislation & jurisprudence*