The upside — and downside — of outpatient surgery
The death of Joan Rivers last fall after a common procedure to examine her digestive tract has sparked concern about outpatient surgical centers, according to Consumer Reports.
Would the comedian be alive today if she had been treated in a hospital? That’s difficult to say. But it’s clear that doctors are doing more outpatient procedures — some of them complicated — and not always on the appropriate patients. So it’s important to make sure that you’re a good candidate before your surgery is scheduled, and to know what to look for in a facility.
The number of outpatient procedures done each year has tripled in the past three decades to about 54 million. And because of shorter-acting anesthesia and less-invasive surgery, people are now going to those facilities for everything from biopsies and knee surgery to mastectomies. Among the most-common procedures are cataract surgery, colonoscopy and endoscopy, the procedure Rivers reportedly had. Many clinics are privately owned by physicians; others are affiliated with hospitals, sometimes even located on hospital grounds.
Though outpatient surgery in general seems safe, some procedures are riskier than others. Your risk also depends on your anesthesia. For deep sedation, or general anesthesia, an anesthesiologist who’s a physician (not a nurse) should always oversee your care, says Dr. Orly Avitzur, medical adviser to Consumer Reports.
HOW TO CHOOSE A CENTER
It’s challenging to find information about specific centers. Unlike hospitals, most outpatient surgery clinics aren’t required to report infections or other complications, and they aren’t inspected by a single organization. That makes it difficult for consumers to compare facilities. Lisa McGiffert, director of the Consumer Reports Safe Patient Project, says more oversight is needed. “Private accreditors are paid to evaluate,” McGiffert says. “And states have different licensing requirements.”
Keep in mind that even a simple procedure in a good center can be a bad idea if you have a serious health problem. In that case, “you face a much higher risk of serious complications and would be better off in a hospital, which can respond to emergencies,” says Dr. Marvin M. Lipman, Consumer Reports’ chief medical adviser. Be leery of outpatient procedures if you have a history of the following: a bleeding disorder; chronic lung disease; congestive heart failure; a heart attack within the past four to six months; serious arrhythmia; serious weight problems; or uncontrolled diabetes.
8 QUESTIONS TO ASK YOUR CLINIC
1. Is it accredited? Check for Medicare certification or accreditation from the Joint Commission, the Accreditation Association for Ambulatory Health Care, the American Association for Accreditation of Ambulatory Surgery Facilities or the Healthcare Facilities Accreditation Program.
2. Who owns it? Outpatient clinics can be a profitable business, so many doctors have invested in them. But that raises ethical concerns because they might have a vested interest in doing more procedures. And just because a doctor owns a facility doesn’t mean it’s the best place for you. So Consumer Reports says to be wary if you are referred to a clinic that’s owned by your doctor.
3. Who is the anesthesiologist? If you need general anesthesia, make sure you’re under the care of someone who is board-certified.
4. How much experience does the doctor have? Look for someone who has performed your procedure at least 50 times in the past year.
5. What’s the emergency plan? Ask whether there’s resuscitative equipment on site and whether your doctor is certified in advanced resuscitation techniques in case something goes wrong.
6. How close is a hospital? Your doctor should have admitting privileges at a nearby hospital in case there is an emergency.
7. What’s the infection rate? Ask how many patients have to be hospitalized because of infections after your procedure. “The goal should be zero,” McGiffert says.
8. What should I do before I’m discharged? Get the name and number of a nurse or doctor to call if you have a problem. Also ask about signs and symptoms to watch for.
2015 Consumers Union Inc.