Clayman Mark A, Caffee Hollis H
Department of Surgery, Division of Plastic & Reconstructive Surgery, University of Florida Health Science Center, Gainesville, Florida 32610, USA.
Ann Plast Surg. 2006 Jan;56(1):78-81. doi: 10.1097/01.sap.0000181668.39120.63.
Office-based surgery has become an important method of healthcare delivery, but there is controversy about its safety. Since 2000, a series of articles were published in the lay media emphasizing the hazards of office surgery, leading to the Florida Board of Medicine restricting office procedures.
The objective of this study was to determine the nature and scope of deaths resulting from office surgery.
We reviewed the data on mandatory reporting by physicians to a central agency of all office surgical incidents that resulted in death, injury, or hospital transfer in the state of Florida from January 2000 to November 2004. E-mail, Internet, and telephone follow up were used to determine physician's board status, office accreditation, and hospital privileges. We reviewed data on medication interactions, anesthesia, and monitoring.
A total of 36 deaths related to office procedures were reported. Only 18 of those were related to surgical procedures that are within the realm of plastic surgery, although surgeons of other specialties did 3 of these. When these 18 were reviewed by type of anesthesia, there were 12 who had general anesthesia, 10 with an anesthesiologist and 2 with a Certified Registered Nurse Anesthetist. Of those 18, 7 died before discharge. Although all 7 of them survived long enough to be transferred to a hospital, we classified them as office deaths. The other 11 died after appropriate discharge. Of the 7 office deaths, one developed bronchospasm during induction by an anesthesiologist. Five were during deep sedation (level III anesthesia) and 4 appeared to be related to excessive sedation and/or inadequate monitoring; the fifth was probably related to illicit drug use and the sixth from a fat embolism. Of the 11 postoperative deaths, 7 were said to be the result of thromboembolism and the others were from unknown causes.
Although the total number of office operations during the study period is unknown, the fact that 7 deaths were reported would suggest that the location in which these procedures were done was not as much of a factor as the regulators have suggested. However, better patient screening, sedation management, deep vein thrombosis prophylaxis, and clinical judgment may have prevented some, if not most, of these deaths. The most frequent cause of death after discharge was thromboembolism, and some of these might have been prevented with better prophylaxis. More detailed findings and recommendations are presented.
门诊手术已成为医疗服务的一种重要方式，但关于其安全性存在争议。自2000年以来，大众媒体发表了一系列文章强调门诊手术的危害，导致佛罗里达州医学委员会对门诊手术程序进行限制。
本研究的目的是确定门诊手术导致死亡的性质和范围。
我们回顾了2000年1月至2004年11月期间佛罗里达州医生向中央机构强制报告的所有导致死亡、受伤或转院的门诊手术事件的数据。通过电子邮件、互联网和电话随访来确定医生的委员会状态、门诊认证和医院特权。我们审查了关于药物相互作用、麻醉和监测的数据。
共报告了36例与门诊手术相关的死亡病例。其中只有18例与整形外科领域内的手术相关，尽管其他专科的外科医生进行了其中3例手术。在按麻醉类型对这18例进行审查时，有12例接受了全身麻醉，其中10例由麻醉医生实施，2例由注册护士麻醉师实施。在这18例中，7例在出院前死亡。尽管他们都存活了足够长的时间被转至医院，但我们将他们归类为门诊死亡。另外11例在适当出院后死亡。在7例门诊死亡病例中，1例在麻醉医生诱导麻醉期间发生支气管痉挛。5例发生在深度镇静（三级麻醉）期间，4例似乎与镇静过度和/或监测不足有关；第5例可能与非法药物使用有关，第6例死于脂肪栓塞。在11例术后死亡病例中，7例据说是血栓栓塞的结果，其他原因不明。
尽管研究期间门诊手术的总数未知，但报告有7例死亡这一事实表明，这些手术的实施地点并非如监管机构所暗示的那样是一个重要因素。然而，更好的患者筛查、镇静管理、深静脉血栓预防和临床判断可能会预防其中一些（如果不是大多数）死亡。出院后最常见的死亡原因是血栓栓塞，其中一些通过更好的预防措施可能是可以避免的。本文还给出了更详细的研究结果和建议。
