Having plastic surgery, endoscopies and other minor surgeries in a doctor's office is risky, a study says.

"Our research compared adverse outcomes and deaths in physicians' offices with those in ambulatory surgical centers," explains study author Dr. Hector Yila, Jr., assistant professor of oncology and anesthesiology at the H. Lee Moffitt Cancer Center in Tampa, Florida. "'We found a much higher death rate and a much higher injury rate when surgery was done in the physician's office," he adds.

The Study

Vila and his colleagues studied all the deaths and injuries during surgery in doctors' offices reported to the Florida Board of Medicine from 2000 through2002. They looked at similar data from ambulatory surgical centers during 2000, reported to the Florida Agency for Health Care Administration.

The study included all types of outpatient surgeries. Vila says most surgeries were plastic surgeries and endoscopies, a procedure using a fiber optic scope to look at the intestinal tract.

Vila's team found that the injury rate in doctors' offices was 66 per 100,000 operations, compared with five per 100,000 surgeries in ambulatory surgical centers. For death, the corresponding numbers were nine per 100,000 in doctors' offices and less than one per 100,000 in ambulatory surgical centers.

The researchers note that if all procedures had been done in surgical centers, approximately 43 injuries and six deaths would have been prevented each year. Vila Believes that this problem is not confined to Florida.

Check Their Credentials

There are many reasons for the dramatic difference in death and injury rates, Vila says, including a lack of equipment and personnel, a lack of set procedures and the inability to deal with emergencies. "Sometimes it's the [lack of] credentials of the people performing the procedure or administering the anesthesia," Vila adds.

"To work in a hospital, a physician has to apply for privileges, but a private physician can do whatever he or she wants in his or her office," Vila says.

In addition, office surgeries are much cheaper than those done in ambulatory surgery centers. Patients concerned with safety need to ask several questions before deciding to have surgery in their doctor's office, Vila advises.

"You should ask your doctor if he has the same standards as those used in the hospital or ambulatory surgical center. Are the physicians board-certified in the specialty that normally performs this procedure? Do they have the same equipment? Do they have emergency resuscitative equipment? Who is going to be giving the anesthesia? And, where will you be taken if there is an emergency?

"If you are unsure, then you should consider having your surgery in an ambulatory surgical center," Vila says.

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