Skin Cancer Center, Cincinnati, Ohio, USA.
Dermatol Surg. 2012 Feb;38(2):171-7. doi: 10.1111/j.1524-4725.2011.02206.x. Epub 2011 Oct 19.
This is a continued examination of 10 years of prospectively collected Florida in-office adverse event data and new comparable data from mandatory Alabama in-office adverse event data reporting.
To determine which office surgical procedures have resulted in reported complications.
This study is a compilation of mandatory reporting of office surgical complications by Florida and Alabama physicians to a central agency. Reports resulting in death or a hospital transfer were further investigated over the telephone or on-line to determine the reporting physician's board certification status, hospital privilege status, and office accreditation status.
In 10 years in Florida, there were 46 deaths and 263 procedure-related complications and hospital transfers; 56.5% (26/46) of deaths and 49.8% (131/263) of hospital transfers were associated with non-medically necessary (cosmetic) procedures. The majority of deaths (67%) and hospital transfers (74%) related to non-medically necessary (cosmetic) procedures were from procedures performed on patients under general anesthesia. Liposuction and liposuction with abdominoplasty or other cosmetic procedure resulted in 10 deaths and 34 hospital transfers. Thirty-eight percent of offices reporting adverse events were accredited by an independent accrediting agency, 93% of physicians were board certified, and 98% of physicians had hospital privileges. The most common specialty of physicians reporting adverse events was plastic surgery (45% of all reported complications). Dermatologists reported four total complications (no deaths) and accounted for 1.3% of all complications over the 10-year period. In 6 years in Alabama, there were three deaths and 49 procedure-related complications and hospital transfers; 42% (22/52) of hospital transfers and no deaths were associated with non-medically necessary (cosmetic) procedures. The majority of hospital transfers related to cosmetic procedures (86%) were from procedures performed on patients under general anesthesia. Liposuction accounted for no deaths and two hospital transfers. Seventy-one percent of offices reporting adverse events were accredited by an independent accrediting agency, and 100% of physicians were board-certified. Plastic surgery was the most common specialty represented in adverse event reporting (42.3% of all reported complications). Dermatologists reported one complication (no deaths) and accounted for 1.9% of all complications over the 6-year period.
Continued analysis reveals that medically necessary office surgery does not represent an emergent hazard to patients. The data obtained from 10 and 6 years of adverse event reporting in Florida and Alabama, respectively, are comparable and consistent. Medically necessary surgical procedures performed in the office setting by dermatologists have an exceedingly low complication rate, and complications that arose were largely unexpected, isolated, and possibly unpreventable. Cosmetic procedures performed in offices by dermatologists under local and dilute local anesthesia yielded no reported complications. Complications from cosmetic procedures accounted for nearly half of all reported incidents in Florida and Alabama, and in both states, plastic surgeons were most represented in adverse event reports. Liposuction performed under general anesthesia requires further investigation because deaths from this procedure continue to occur despite the ability to use dilute local anesthesia for this procedure. Requiring physician board certification and physician hospital privileges does not seem to increase safety of patients undergoing surgical procedures in the office setting. Mandatory reporting of adverse events in the office setting should continue to be championed. Reporting of delayed deaths after hospital outpatient and ambulatory surgery center procedures should be implemented. All data should be made available for scientific analysis after protecting patient confidentiality.
这是对佛罗里达州前瞻性收集的 10 年门诊不良事件数据和阿拉巴马州强制性门诊不良事件报告的新可比数据的持续检查。
确定哪些门诊手术会导致报告的并发症。
本研究是对佛罗里达州和阿拉巴马州医生向中央机构强制性报告门诊手术并发症的汇编。导致死亡或转院的报告通过电话或在线进一步调查，以确定报告医生的委员会认证状态、医院特权状态和办公室认证状态。
在佛罗里达州的 10 年中，有 46 人死亡和 263 例与手术相关的并发症和医院转院；56.5%（26/46）的死亡和 49.8%（131/263）的医院转院与非医疗必要（美容）手术有关。大多数死亡（67%）和医院转院（74%）与非医疗必要（美容）手术有关的患者是在全身麻醉下进行的手术。吸脂术和吸脂术联合腹部整形术或其他美容手术导致 10 人死亡和 34 人住院转院。报告不良事件的办公室中有 38%获得了独立认证机构的认证，93%的医生获得了委员会认证，98%的医生拥有医院特权。报告不良事件的最常见专业是整形手术（所有报告并发症的 45%）。皮肤科医生共报告了 4 例总并发症（无死亡），占 10 年期间所有并发症的 1.3%。在阿拉巴马州的 6 年中，有 3 人死亡和 49 例与手术相关的并发症和医院转院；42%（22/52）的医院转院和无死亡与非医疗必要（美容）手术有关。大多数与美容手术有关的医院转院（86%）是在全身麻醉下进行的手术。吸脂术未导致死亡和 2 例医院转院。报告不良事件的办公室中有 71%获得了独立认证机构的认证，并且 100%的医生都获得了委员会认证。整形手术是报告不良事件中最常见的专业（所有报告并发症的 42.3%）。皮肤科医生报告了 1 例并发症（无死亡），占 6 年期间所有并发症的 1.9%。
持续分析表明，医疗必要的门诊手术不会对患者造成紧急危害。分别来自佛罗里达州和阿拉巴马州 10 年和 6 年不良事件报告的数据是可比和一致的。皮肤科医生在办公室环境中进行的医疗必要手术并发症发生率极低，而且出现的并发症大多是意外的、孤立的，可能是无法预防的。皮肤科医生在办公室环境中使用局部和稀释局部麻醉进行的美容手术没有报告并发症。佛罗里达州和阿拉巴马州的所有报告事件中，约有一半与美容手术有关，在这两个州，整形医生在不良事件报告中占比最大。全身麻醉下进行的吸脂术需要进一步调查，因为尽管可以使用稀释的局部麻醉进行该手术，但仍有死亡病例发生。要求医生获得委员会认证和医院特权似乎并不能提高患者在办公室环境中接受手术的安全性。应继续倡导在门诊环境中报告不良事件。应实施对医院门诊和日间手术中心手术后延迟死亡的报告。在保护患者隐私的前提下，应将所有数据用于科学分析。
