Coldiron Brett M, Healy Chris, Bene Natalie I
Department of Dermatology, University of Cincinnati, Cincinnati, Ohio, USA.
Dermatol Surg. 2008 Mar;34(3):285-91; discussion 291-2. doi: 10.1111/j.1524-4725.2007.34060.x. Epub 2007 Dec 20.
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.
The objective was to determine the nature and incidence of hospital transfers and deaths resulting from office procedures.
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.
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).
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.
随着媒体对医疗领域人为失误的关注度不断提高，众多州医学委员会和立法机构已经起草并仍在继续起草旨在保护在门诊环境中接受手术的患者的法规。这些法规将对患者获得必要医疗手术的机会产生重大影响，并且任何法规都应基于可靠的数据。本报告总结了来自佛罗里达州的7年前瞻性数据，这是关于门诊手术事故的现有最佳数据。
目的是确定门诊手术导致的医院转诊和死亡的性质及发生率。
本研究汇总了2000年3月至2007年3月期间佛罗里达州医生向中央机构强制报告的该州所有导致死亡、重伤或医院转诊的门诊不良事件。通过电话和互联网进行随访，以确定报告医生的委员会认证、医院特权和门诊认证情况。
7年中有31例死亡以及143例与手术相关的并发症和医院转诊。抽脂术以及抽脂术联合腹部整形术或其他美容手术导致了24例并发症和8例死亡。在报告不良事件的门诊中，38.5%获得了独立认证机构的认证，92.5%的医生获得了委员会认证，96.6%的医生拥有医院特权。总共58%（18/31）的死亡和61%（87/143）的并发症与非必要医疗（美容）手术相关。这些死亡病例中共有78%（14/18）为ASA 1级患者。整形外科医生占所有死亡病例的48%（美容手术死亡病例的83%），占所有医院转诊病例的52%（美容手术并发症和医院转诊病例的83%）。
整形外科医生导致的死亡和医院转诊数量过多。要求医生获得委员会认证和医院特权似乎并不会提高安全性，因为大多数医生已经具备这些资质，而且没有这些资质的医生在不良事件中所占比例并不高。这些数据并未显示必要医疗门诊手术会对患者造成紧急危害。全身麻醉下的抽脂术值得持续关注，因为该手术仍有死亡病例发生，而该手术也可以在局部浸润麻醉下进行，且局部浸润麻醉未报告有死亡病例。应大力支持强制报告门诊事件，以及报告医院门诊部和门诊手术中心手术后发生的事件。在保护患者隐私后，这些数据应可供分析。需要进行全国性辩论，以确定在全身麻醉和静脉麻醉下进行的美容手术可接受的死亡和受伤数量。
