Surgeries that were once performed only in a hospital or surgery centers are becoming more common in converted examining rooms and surgical suites in physicians' offices.

Many of these procedures require general anesthesia or intravenous (IV) sedation. Yet, in some states, there are no standards, regulations, or accreditation requirements for surgeries performed in physician offices.

"It used to be that the only [procedures] done in physician offices were dermatologic or plastic surgery, primarily under a local anesthetic," says Rebecca Twersky, MD, a New York-based anesthesiologist who helped write the American Society of Anesthesiologists' guidelines for office-based anesthesia. "Now we're seeing oral surgery, orthopedics, podiatry, and general surgery."

Safety Concerns

Dr. Twersky warns that without the same safety regulations as hospital surgery, office-based surgeries could cause serious complications. There have already been reports of deaths resulting from the following situations:

• Staff was unprepared and untrained to manage cardiac arrest or breathing problems
• Staff called 911 too late or not at all, for fear of reporting
• Drugs and/or equipment were outdated
• Lengthy surgery was done on a medically unfit patients

Why Have Surgery in the Office?

The trend toward office-based surgery is driven by several factors, including:

• Cost
• Patients' wishes for privacy and convenience
• Flexibility in scheduling
• Wider availability of smaller patient monitors and other surgical and anesthesia equipment
• Newer anesthetics that work faster and wear off more quickly

Standards

Hospitals and surgery centers must meet strict state and federal licensing and accreditation guidelines. They also have medical boards that oversee practitioners' qualifications and credentials. Inconsistent standards exist for office-based surgery. Some states have addressed the issue of office-based surgery and implemented regulatory requirements while others are relatively unregulated.

The Anesthesia Factor

Once you move from local anesthesia to IV sedation or general anesthesia, the risk for complications such as respiratory distress or heart attack increases. In rare cases, patients can even have a life-threatening reaction to local anesthesia, says Dr. Twersky.

Who Should Not Have Surgery in a Doctor's Office?

Regardless of how minor the surgery, certain patients, particularly those with serious health conditions, such as diabetes, heart disease, or uncontrolled high blood pressure, should not have surgery in a physician's office, says Dr. Twersky.

Be Informed

Before you have surgery in a doctor's office, the American Society of Anesthesiologists recommends that you ask the following questions:

• Is the office accredited for surgery and anesthesia?
• Does the doctor have credentials to perform the surgery in a hospital or outpatient surgery center?
• Will a qualified anesthesiologist or certified registered nurse anesthetist (supervised by an anesthesiologist or other qualified physician) give the anesthesia? (You should meet this person before your surgery, and she should remain with you until you wake up.)
• Is the anesthesia equipment equivalent to that used in a hospital or ambulatory surgical facility?
• Does the doctor have the necessary equipment and drugs to handle any emergencies?
• Which hospital will you be admitted to if complications occur?
• Will qualified and trained staff monitor your recovery?
• Is the recovery area equipped similarly to one in a hospital or ambulatory surgery facility?
• Will a physician decide if you are ready to be discharged? (A nurse could follow a doctor's orders based on objective criteria.)
• Is someone in the office certified in advanced cardiac life support (ACLS)?
• If a child is having the surgery, is someone trained in pediatric life support? Are equipment and drugs specifically for children available?

"We're not saying don't have the surgery in a physician's office," says Dr. Twersky. "But be aware of the risks involved and make sure that you're safeguarding yourself."