The tragic passing of Joan Rivers has again raised awareness surrounding the dangers of medical procedures. Without getting into specific details about Joan’s case (many of the details are still emerging and a lot is still unknown), I would like to comment generally about the safety of medical procedures, particularly ones that utilize general anesthesia or sedation.
In general, when performed in a certified and accredited facility, medical procedures under general anesthesia or sedation are extremely safe. Certification means that the facilities meet high standards for safety. They are required to have medical equipment and a well-trained staff that can respond to any medical emergency that may arise. This will enable the outpatient or ambulatory facility to stabilize the patient so that he or she can be transported to a nearby hospital for more specialized emergency treatment.
There are a variety of surgical procedures that can safely be performed at an outpatient facility, even when general anesthesia is used. I personally perform 500 surgeries per year in an accredited office operating room. All my patients are given deep intravenous sedation or general anesthesia and are discharged home a few hours after the procedure when they are medically stable. I have a Board Certified Anesthesiologist on staff whose sole responsibility is to monitor and care for the patient. Under no circumstance, should the plastic surgeon be the one responsible for the sedation or anesthesia. This is accepted standard of care and many procedures ranging from cosmetic surgery to endoscopic procedures are performed in this way.
The idea that an elderly patient must always have a procedure done in a hospital is not always true. Age itself is not the only factor. Many 80 year olds are in better health than some 40 year olds. More important in deciding where to perform a surgery is the patient’s overall health and the risks of the actual procedure being performed. In accredited ambulatory facilities, every patient is required to have a physical exam to determine health. If the patient ahs significant medical issues, than the physician may require that the procedure is performed in a hospital. Also, if the planned procedure carries significant risks for complications, than a hospital may be the more appropriate setting. This enables that in the event of an emergency, there are many specialists in the same building who can quickly respond if needed. Also, it allows for the patient to be more closely monitored after the surgery, and even kept overnight or for a few days.
The key to all this is that safety is the ultimate goal, in some cases, safety concerns warrant that a procedure be performed in a hospital. This unfortunate and tragic case should not initiate calls to stop all outpatient or office-based surgeries. Hundreds-of-thousands of procedures are safely performed every year in outpatient or office facilities. As the details of Joan River’s case come out, we may learn that things were done improperly or perhaps we will learn that the standard-of-care was followed and that this was simply a one-in-a-million complication that could have happened anywhere, even in a hospital. At the very least, this should expand the dialogue between patients and doctors about the risks surrounding any medical procedure.