Office surgery safety: the myths and truths behind the Florida moratoria--six years of Florida data.
BACKGROUND
Office-based surgery is an important method of health care delivery, and in 2000, the Florida Board of Medicine restricted office procedures. The objective of this study was to analyze the deaths resulting from office procedures in Florida.


METHODS
The authors reviewed all office surgical incidents that resulted in death, injury, or hospital transfer in Florida from January of 2000 to January of 2006. Various methods were used to determine board status, office accreditation, and hospital privileges.


RESULTS
In 6 years of Florida data, a total of 46 deaths related to office procedures were reported. Twenty of those were surgical procedures that are within the scope of plastic surgery, although non-board-certified plastic surgeons performed nine. Of those 20 related to plastic surgery, 11 died before discharge. Although all 11 survived long enough to be transferred to a hospital, we classified them as office deaths. The other nine died after appropriate discharge. Of the nine, seven deaths were from thromboembolism and the others from unknown causes. Thirty-five deaths were related to non-board-certified plastic surgeons and specialists in other fields. Board-certified plastic surgeons accounted for less than one-fourth of the deaths. There were no deaths from a board-certified plastic surgeon since April of 2004.


CONCLUSIONS
There were over 600,000 operations during the study period. The fact that 11 office deaths were reported would suggest that the location in which these procedures were performed was not as much of a factor as the regulators have suggested. The most frequent cause of death after discharge was thromboembolism.
Clayman
Mark A
MA
Division of Plastic and Reconstructive Surgery, University of Florida College of Medicine, USA. mclayman@ufl.edu
Seagle
Brent M
BM
D000068:Accreditation / Q000706:statistics & numerical data; D000328:Adult; D000556:Ambulatory Surgical Procedures / Q000009:adverse effects / Q000331:legislation & jurisprudence* / Q000401:mortality / Q000592:standards / Q000706:statistics & numerical data; D000758:Anesthesia; D001145:Arrhythmias, Cardiac / Q000401:mortality; D019274:Botulinum Toxins, Type A / Q000009:adverse effects; D001986:Bronchial Spasm / Q000401:mortality; D003625:Data Collection; D004342:Drug Hypersensitivity / Q000401:mortality; D004620:Embolism, Fat / Q000401:mortality; D017809:Fatal Outcome; D005260:Female; D005431:Florida / Q000453:epidemiology; D006075:Governing Board; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007431:Intraoperative Complications / Q000401:mortality*; D015187:Lipectomy / Q000401:mortality; D016462:Mammaplasty / Q000401:mortality; D008504:Medical Staff Privileges / Q000706:statistics & numerical data; D008875:Middle Aged; D019647:Oral Surgical Procedures / Q000401:mortality; D011183:Postoperative Complications / Q000401:mortality*; D019651:Plastic Surgery Procedures / Q000401:mortality; D012225:Rhinoplasty / Q000401:mortality; D015361:Rhytidoplasty / Q000401:mortality; D012308:Risk Management; D013923:Thromboembolism / Q000401:mortality
D019274:Botulinum Toxins, Type A