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Office-based surgeries v. ASCs: The debate heats up

Ambulatory Safety Monitor, January 27, 2005

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In response to the publication of an article in Dermatologic Surgery magazine about a study claiming that some surgical procedures are safer when performed in a physician's office rather than an ASC (a story Ambulatory Safety Monitor reported on in its Jan. 6 edition), opinions on the issue are flying fast and furious throughout the healthcare industry.

According to the news service PR Newswire, Dr. Marc E. Koch, the president and CEO of anesthesia service provider Somnia, believes that the magazine account of the study conducted by Dr. Brett Coldiron and his team is "way off base, and can do patients a serious disservice through the propagation of misleading information." Koch argues that the issue at the heart of the debate is not the type of anesthesia primarily being used in the two venues (general in ASCs and local in doctors' offices), but the persons most often administering anesthesia in these two venues.

Koch argues that office-based surgeries frequently see nurses and other non-anesthesiologists taking responsibility for administering anesthesia, which he says is less safe for patients than the trained physician anesthesiologists who administer sedation in ASCs. "In a day and age when specialization is the medical mantra," says Koch, "downgrading the standard of care when it comes to office-based anesthesia seems curiously if not dangerously provocative."

In addition to the concerns raised by Koch, the News Tribune of Tacoma, WA reported January 20 that state health officials in Washington are planning to suggest new guidelines this spring that will require doctors' offices to undergo the sort of regular safety inspections that surgery centers and hospitals do, something not currently required by law. Any adoption of those safety measures, however, is expected to be at least a year away, according to the article.

Meanwhile, in an attempt to help educate patients enough to make their own decision on the issue, the American Association of Nurse Anesthetists (AANA) has published a new educational brochure, titled Office Based Anesthesia: What Every Patient Should Know to Prepare for Surgery and Anesthesia in a Physician's Office. The publication is available, at no charge for a single copy, by contacting the AANA Bookstore at www.aana.com/bookstore.

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