Joan Rivers’ recent death highlights that outpatient surgery often
comes with certain risks. The comedian and talk show host went into cardiac
arrest during a reportedly minor throat surgery at a Manhattan doctor’s
office and was rushed by ambulance to Mt. Sinai Hospital late last month.
According to the latest statistics, more than 60 percent of surgical procedures
are now performed in the outpatient setting. Even more concerning, the
procedures performed in doctor’s offices and surgical centers are
increasingly complex, ranging from plastic surgery to cancer operations.
Also, patients are not always young and healthy, but often include higher-risk
While outpatient surgery is generally considered safe, there are risks
that must be addressed. One concern is that surgeries at outpatient facilities
are not subject to the same oversight as traditional hospitals, leading
to an increased risk of medical errors. When complications do arise, many
facilities are not equipped to address them and must transfer patients
to other facilities, which can delay emergency care.
By way of example, a
recent study by the University of Michigan Health System found that the risk of of venous thromboembolism—dangerous blood
clots that can form in the veins and travel to the lungs—are significantly
higher in patients who undergo outpatient surgery. Moreover, patients
are not always properly advised of the risks.
“These data are in stark contrast to provider and patient expectations
that outpatient surgery is a low-risk event,” lead study author
Christopher J. Pannucci, M.D., stated. “It also underscores the
importance of evaluating a patient’s individual risk factors as
opposed to procedure-type alone.”
After five Southern California patients died after undergoing weight loss
procedures at outpatient facilities in 2012, California enacted a new
law that increases state oversight. Among other requirements, it mandates
that the Medical Board of California maintain a list of accredited outpatient
settings, including the names of all doctor-owners and their medical license
numbers. It is also requires the Board to document on its website whenever
a surgery center has its accreditation revoked or suspended or the center
is placed on probation.
For patients considering outpatient surgery, it is important to investigate
the risk of the procedure and the safety record of the facility. You should
also ask your doctor if there are any aspects of your own health history
that may increase the likelihood or seriousness of a complication.