title: Is Office-Based Surgery Safe? Comparing Outcomes of 183,914 Aesthetic Surgical Procedures Across Different Types of Accredited Facilities.
abstract: BACKGROUND
  There has been a dramatic rise in office-based surgery. However, due to wide variations in regulatory standards, the safety of office-based aesthetic surgery has been questioned.
  
  
  OBJECTIVE
  This study compares complication rates of cosmetic surgery performed at office-based surgical suites (OBSS) to ambulatory surgery centers (ASCs) and hospitals.
  
  
  METHODS
  A prospective cohort of patients undergoing cosmetic surgery between 2008 and 2013 were identified from the CosmetAssure database (Birmingham, AL). Patients were grouped by type of accredited facility where the surgery was performed: OBSS, ASC, or hospital. The primary outcome was the incidence of major complication(s) requiring emergency room visit, hospital admission, or reoperation within 30 days postoperatively. Potential risk factors including age, gender, body mass index (BMI), smoking, diabetes, type of procedure, and combined procedures were reviewed.
  
  
  RESULTS
  Of the 129,007 patients (183,914 procedures) in the dataset, the majority underwent the procedure at ASCs (57.4%), followed by hospitals (26.7%) and OBSS (15.9%). Patients operated in OBSS were less likely to undergo combined procedures (30.3%) compared to ASCs (31.8%) and hospitals (35.3%, P < .01). Complication rates in OBSS, ASCs, and hospitals were 1.3%, 1.9%, and 2.4%, respectively. On multivariate analysis, there was a lower risk of developing a complication in an OBSS compared to an ASC (RR 0.67, 95% CI 0.59-0.77, P < .01) or a hospital (RR 0.59, 95% CI 0.52-0.68, P < .01).
  
  
  CONCLUSIONS
  Accredited OBSS appear to be a safe alternative to ASCs and hospitals for cosmetic procedures. Plastic surgeons should continue to triage their patients carefully based on other significant comorbidities that were not measured in this present study. LEVEL OF EVIDENCE 3.
authors.affiliation: Drs Gupta and Higdon are Assistant Professors, Drs Nguyen and Afshari are Research Fellows, and Dr Shack is a Professor and Chairman, Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, TN. Dr Nguyen is also a General Surgey Resident, Department of Surgery, Morristown Medical Center, Morristown, NJ, and Dr Afshari is also a General Surgery Resident, Department of General Surgery, University of South Carolina, Columbia, SC. Dr Parikh is a plastic surgeon in private practice in Bellevue, WA. Dr Grotting is a Clinical Professor, Division of Plastic Surgery, University of Alabama at Birmingham, Birmingham, AL; and CME/MOC Section Editor for Aesthetic Surgery Journal.
authors.forename: Varun
authors.initials: V
authors.lastname: Gupta
authors.affiliation: Drs Gupta and Higdon are Assistant Professors, Drs Nguyen and Afshari are Research Fellows, and Dr Shack is a Professor and Chairman, Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, TN. Dr Nguyen is also a General Surgey Resident, Department of Surgery, Morristown Medical Center, Morristown, NJ, and Dr Afshari is also a General Surgery Resident, Department of General Surgery, University of South Carolina, Columbia, SC. Dr Parikh is a plastic surgeon in private practice in Bellevue, WA. Dr Grotting is a Clinical Professor, Division of Plastic Surgery, University of Alabama at Birmingham, Birmingham, AL; and CME/MOC Section Editor for Aesthetic Surgery Journal.
authors.forename: Rikesh
authors.initials: R
authors.lastname: Parikh
authors.affiliation: Drs Gupta and Higdon are Assistant Professors, Drs Nguyen and Afshari are Research Fellows, and Dr Shack is a Professor and Chairman, Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, TN. Dr Nguyen is also a General Surgey Resident, Department of Surgery, Morristown Medical Center, Morristown, NJ, and Dr Afshari is also a General Surgery Resident, Department of General Surgery, University of South Carolina, Columbia, SC. Dr Parikh is a plastic surgeon in private practice in Bellevue, WA. Dr Grotting is a Clinical Professor, Division of Plastic Surgery, University of Alabama at Birmingham, Birmingham, AL; and CME/MOC Section Editor for Aesthetic Surgery Journal.
authors.forename: Lyly
authors.initials: L
authors.lastname: Nguyen
authors.affiliation: Drs Gupta and Higdon are Assistant Professors, Drs Nguyen and Afshari are Research Fellows, and Dr Shack is a Professor and Chairman, Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, TN. Dr Nguyen is also a General Surgey Resident, Department of Surgery, Morristown Medical Center, Morristown, NJ, and Dr Afshari is also a General Surgery Resident, Department of General Surgery, University of South Carolina, Columbia, SC. Dr Parikh is a plastic surgeon in private practice in Bellevue, WA. Dr Grotting is a Clinical Professor, Division of Plastic Surgery, University of Alabama at Birmingham, Birmingham, AL; and CME/MOC Section Editor for Aesthetic Surgery Journal.
authors.forename: Ashkan
authors.initials: A
authors.lastname: Afshari
authors.affiliation: Drs Gupta and Higdon are Assistant Professors, Drs Nguyen and Afshari are Research Fellows, and Dr Shack is a Professor and Chairman, Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, TN. Dr Nguyen is also a General Surgey Resident, Department of Surgery, Morristown Medical Center, Morristown, NJ, and Dr Afshari is also a General Surgery Resident, Department of General Surgery, University of South Carolina, Columbia, SC. Dr Parikh is a plastic surgeon in private practice in Bellevue, WA. Dr Grotting is a Clinical Professor, Division of Plastic Surgery, University of Alabama at Birmingham, Birmingham, AL; and CME/MOC Section Editor for Aesthetic Surgery Journal.
authors.forename: R Bruce
authors.initials: RB
authors.lastname: Shack
authors.affiliation: Drs Gupta and Higdon are Assistant Professors, Drs Nguyen and Afshari are Research Fellows, and Dr Shack is a Professor and Chairman, Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, TN. Dr Nguyen is also a General Surgey Resident, Department of Surgery, Morristown Medical Center, Morristown, NJ, and Dr Afshari is also a General Surgery Resident, Department of General Surgery, University of South Carolina, Columbia, SC. Dr Parikh is a plastic surgeon in private practice in Bellevue, WA. Dr Grotting is a Clinical Professor, Division of Plastic Surgery, University of Alabama at Birmingham, Birmingham, AL; and CME/MOC Section Editor for Aesthetic Surgery Journal.
authors.forename: James C
authors.initials: JC
authors.lastname: Grotting
authors.affiliation: Drs Gupta and Higdon are Assistant Professors, Drs Nguyen and Afshari are Research Fellows, and Dr Shack is a Professor and Chairman, Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, TN. Dr Nguyen is also a General Surgey Resident, Department of Surgery, Morristown Medical Center, Morristown, NJ, and Dr Afshari is also a General Surgery Resident, Department of General Surgery, University of South Carolina, Columbia, SC. Dr Parikh is a plastic surgeon in private practice in Bellevue, WA. Dr Grotting is a Clinical Professor, Division of Plastic Surgery, University of Alabama at Birmingham, Birmingham, AL; and CME/MOC Section Editor for Aesthetic Surgery Journal.
authors.forename: K Kye
authors.initials: KK
authors.lastname: Higdon
mesh_terms: D000068:Accreditation / Q000592:standards; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000554:Ambulatory Care Facilities; D000556:Ambulatory Surgical Procedures / Q000009:adverse effects / Q000592:standards; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D015897:Comorbidity; D003357:Cosmetic Techniques / Q000009:adverse effects / Q000592:standards; D016208:Databases, Factual; D004954:Esthetics; D005260:Female; D006268:Health Facilities / Q000592:standards; D006761:Hospitals; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D061214:Patient Safety / Q000592:standards; D011183:Postoperative Complications / Q000209:etiology*; D017064:Process Assessment, Health Care / Q000592:standards; D011446:Prospective Studies; D019651:Plastic Surgery Procedures / Q000009:adverse effects / Q000592:standards; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult