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Determining the Safety of Office-Based Surgery: What Mandatory Reporting Data Reveal

Clear and compelling evidence shows that in-office procedures by dermatologists are extremely free of serious complications.

Mandatory reporting of in-office adverse events has been implemented by several states, including Florida and Alabama. These authors reviewed the publicly available data on in-office adverse events from the Agency for Health Care Administration in Florida for 2000–2010 and from the Alabama Board of Medical Examiners for 2003–2009.

In Florida, 46 deaths and 263 serious complications and hospital transfers occurred related to office surgical complications. Of these, 56.5% and 49.8%, respectively, were associated with cosmetic procedures. Of these cosmetic procedures, 67% and 74% were under general anesthesia. Liposuction, with or without abdominoplasty, was involved in 10 deaths and 34 hospital transfers. The specialty most often reporting complications was plastic surgery (45% of all complications). Dermatology accounted for 1.3% of all complications and no deaths. Adjusted by number of specialists per state, dermatologists had lower rates of in-office complications than gastroenterologists, nephrologists, obstetricians and gynecologists, radiologists, otolaryngologists, and vascular surgeons.

The results from Alabama were similar, with 3 deaths and 49 hospital transfers; 42% of hospital transfers and no deaths were associated with cosmetic procedures, and 86% of hospital transfers involved surgeries under general anesthesia. Liposuction accounted for two transfers and no deaths. Plastic surgeons reported 42.3% of the complications, and dermatologists reported 1.9% (1 complication) and no deaths. The authors conclude that office-based surgery by dermatologists is demonstrably safe, with extremely few complications. When liposuction complications occurred, the associated procedures were overwhelmingly performed under general anesthesia, rarely used by dermatologists.

Comment: Despite media suggestions that office-based surgery is dangerously unregulated and the province of incompetent and careless physicians, this is not the case. Far from validating this hypothesis, data from states with mandatory reporting indicate that in-office procedures are safe. When adjusted for number of specialists per state, the risk for serious adverse events for plastic surgeons was 50–100 times that for dermatologists. This finding may in part reflect that dermatologists are extremely skilled with local and tumescent anesthesia and do not require general anesthesia, even for more-invasive procedures such as liposuction. Although this report will not end the ongoing debate about site of service, it provides clear and compelling evidence that dermatologists are safe proceduralists, capable of self-regulation in an office setting.

— Murad Alam, MD, MSCI

Published in Journal Watch Dermatology April 13, 2012

Citation(s):

Starling J III et al. Determining the safety of office-based surgery: What 10 years of Florida data and 6 years of Alabama data reveal. Dermatol Surg 2012 Feb; 38:171.

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Review and add to remarks on this article

• Study bias
  Thomas Fiala, 17 Apr 2012 11:20 AM EST
  Specialty: Plastic Surgery
  Was the volume of liposuction controlled for in this study? How about the type of anesthesia - local versus IV... [more]

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