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Monday, September 8, 2014

Joan Rivers and outpatient surgery environment, shouldn't be done?

The death of a comedic icon, Joan Rivers is unfortunate and has shed a spotlight on the topic surgical settings. 

Reality is that mortality, death, can happen even in the most minor of procedures either in the hospital , office based surgery or the ambulatory surgery outpatient setting.    The regulations in place for all outpatient surgery requiring anesthetics of any kind that is more than local anesthesia (commonly referred to as novacaine)  is very strict by various state laws.  

Due to insurance and government's efforts to control costs more procedures are going outpatient to the latter two of the facilities.   Cost savings are enormous for the government, insurance carriers and to patients.   
Hospitals usually charge and receive up to 3 times the reimbursement for the same procedures done at outpatient facilities while doctors are paid similar regardless of facilities chosen. 
The question that was brought up recently was safety, is it safe? 

Yes, the outpatient facilities are just as safe as hospitals and are under tighter scrutiny, just ask the administrators of those outpatient facilities.   If sedation or general anesthetics are used the surgeon as well as the anesthesiologist are both required to be certified by American Heart Association in Advanced Cardiac Life Support.     The same doctors responsible for life saving actions in the hospitals are present during outpatient surgeries as well as same drugs. 

The media seems to spin things out of proportion for ratings.    The outpatient facilities tend to deal with cleaner cases which also tends to lower infection rates vs hospital setting.  This is a big plus for patients.    Hospital acquired infections are less common in the outpatient setting as there are no long term patients undergoing dirty procedures such as a perforated bowel, MRSA wound washouts, etc.

The other topic being brought up is should an 81 year old have elective surgery?    Some 40 year olds I've seen are in worse shape health wise then my 85 year olds that walk 5 miles a day etc.    Age is nothing but a number is correct,  the health age is more important.   Just because a person is over 65 does not mean they are over the hill for elective surgeries.  For myself as a podiatrist, most of what I do is elective such as bunions, hammertoes, fusions, ankle arthroscopies, as long as the patient is healthy enough and active risk of anesthesia death is relatively low.


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