Office surgery incidents: what seven years of Florida data show us.  
 

Coldiron BM, Healy C, Bene NI.Dermatol Surg. 2008 Mar;34(3):285-91; discussion 291-2. Epub 2007 Dec 20.

Patient safety in ambulatory surgery centers (ASCs) has received increasing attention, and the Joint Commission’s National Patient Safety Goals now include specific requirements for ASCs. This study summarizes the types and severity of adverse events occurring in ASCs in Florida, gathered using that state’s mandatory reporting system. The majority of deaths and hospital transfers occurred in patients undergoing cosmetic procedures, incidents that are generally considered never events. A previous AHRQ WebM&M commentary and perspective discuss the issues pertaining to improving safety in outpatient surgery, which remains a largely unregulated area.

BACKGROUND: In the wake of increased media attention focusing on human error in medicine, numerous state medical boards and legislatures have drafted, and are continuing to draft, regulations aimed at protecting patients undergoing procedures in the office setting. These regulations will have a considerable impact on patient access to medically necessary procedures, and any regulations should be based on good data. This report summarizes 7 years of prospective data from the state of Florida, the best data available on office surgery incidents.

OBJECTIVE: The objective was to determine the nature and incidence of hospital transfers and deaths resulting from office procedures.

METHODS: This study is a compilation of mandatory reporting by Florida physicians to a central agency of all in-office adverse incidents resulting in death, serious injury, or hospital transfer in the State of Florida from March 2000 to March 2007. Telephone and internet follow-up was conducted to determine reporting physician board certification, hospital privileges, and office accreditation.

RESULTS: In 7 years there were 31 deaths and 143 procedure-related complications and hospital transfers. Liposuction and liposuction with abdominoplasty or another cosmetic procedure resulted in 24 complications and 8 deaths. Of the offices reporting adverse incidents, 38.5% were accredited by an independent accrediting agency, 92.5% of the physicians were board-certified, and 96.6% had hospital privileges. A total of 58% (18/31) of the deaths and 61% (87/143) of the complications were associated with nonmedically necessary (cosmetic) procedures. A total of 78% (14/18) of these deaths were in ASA Class 1 patients. Plastic surgeons were responsible for 48% of all deaths (83% of cosmetic surgery deaths) and for 52% of all hospital transfers (83% of cosmetic surgery complications and hospital transfers).

CONCLUSION: Plastic surgeons were responsible for an inordinate number of deaths and hospital transfers. Requiring physician board certification and physician hospital privileges would not seem to increase safety, because most physicians already have these credentials, and physicians without these credentials were not responsible for a disproportionate share of incidents. These data do not show an emergent hazard to patients from medically necessary office surgery. Liposuction under general anesthesia deserves continued scrutiny because deaths due to this procedure continue to occur and this procedure can be performed with dilute local anesthesia, with which no deaths were reported. Mandatory reporting of office incidents should be strongly supported, as well as reporting of incidents that occur after surgery in the hospital outpatient department and ambulatory surgery center. These data should be available for analysis after protecting patient confidentiality. A national debate needs to occur to determine how many deaths and injuries are acceptable from cosmetic procedures performed under general and intravenous anesthesia.
 

By Will Dunham

WASHINGTON (Reuters) - A surprising number of people — more than 60 percent — still suffer significant pain a year after a traumatic injury in a car crash or other cause, showing the need for better pain treatment, researchers said.

In a study published on Monday in the journal Archives of Surgery, researchers tracked 3,047 patients ages 18 to 84 from 14 U.S. states who survived an acute traumatic injury.

A year after the injury, 63 percent reported that they still experienced pain related to the injury, with most having pain in more than one region of the body.

On average, the patients assessed their pain at 5.5 on a 10-point scale — a level at which they would be expected to have moderate to severe interference with daily activities.

“I was surprised that the pain was as common and as severe as they reported it to be,” said Dr. Frederick Rivara of the University of Washington in Seattle, who led the study.

“The implications are that we need to do a much better job of identifying pain in these patients, treating it adequately and treating it early,” Rivara added in a telephone interview.

The people in the study sustained head injuries, broken limbs, chest or abdominal trauma and other injuries in motor vehicle crashes, falls and other circumstances.

Pain was most commonly seen in joints and limbs (44 percent of patients), the back (26 percent), the head (12 percent) and neck (7 percent).

Rivara noted that people who experience chronic pain are at higher risk for depression and for being unable to work or function normally.

“The focus up until now in a lot of our care is on whether you live or die, which is obviously important. But we can’t just stop there. And I think we need to look at what are the things we can do to improve people’s lives after serious illness or injury,” Rivara added.

The American Pain Foundation, a Baltimore-based advocacy group, said the financial cost exacted by chronic pain in the United States — including health-care expenses, lost income and lost productivity — is estimated at $100 billion a year.

The group said back pain is the leading cause of disability in Americans under 45 years old.

“There are hundreds of thousands, if not millions, of people who have had traumatic injury when the focus has been the injury and the destruction of tissue and not the pain. Pain has been a secondary consideration (during treatment),” said Will Rowe, American Pain Foundation chief executive officer.

“In many instances, the injury heals and the pain persists. That’s the story that needs to be told,” Rowe said.