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Is Outpatient Surgery More Risky?

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 populations.

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.