Patient safety in the office-based surgical setting

Abstract

Robert Singer, MD Geoffrey R. Keyes, MD Jeffrey L. Apfelbaum, MD Charles E. Hughes III, MD Dr. Singer: Enhancing patient safety has been an ongoing effort of the American Society for Aesthetic Plastic Surgery, the Aesthetic Surgery Education and Research Foundation, the American Society of Plastic Surgeons, and the Plastic Surgery Educational Foundation. The panelists will be presented with hypothetical clinical situations as a means of highlighting and discussing some current safety concerns, as well as asked to provide their recommendations for maximizing patient safety. The first case involves a 58-year-old man who is scheduled to undergo a face lift and bilateral upper- and lower-lid blepharoplasty (Case 1). His preoperative blood pressure is 165/95 mm Hg. He prefers that the surgery be performed in an office-based setting. Dr. Hughes, what concerns would you have, and what approach to this patient would you take? Dr. Hughes: I am assuming that this patient's increased blood pressure was ascertained in the preoperative examination and that he previously was unaware of the problem. However, even if he was taking medication for high blood pressure and his hypertension represented anxiety, I would want his internist to evaluate his condition to make certain that all issues had been addressed. Normally, with input from the internist and treatment to reduce the patient's blood pressure to a normotensive level, I could certainly proceed. If the internist agrees that it would be reasonable to perform surgery in an office-based setting once the blood pressure is reduced to a normal range, I think you can proceed without a problem. ### Case 1: 58-year-old man | Desired surgery: | Face lift, neck lift, blepharo-plasty; patient prefers surgery in an office-based setting | || | History: | Blood pressure on preoperative visit was 165/95 mm Hg | | Follow-up: | Patient experiences chest pain in the recovery room | Dr. Singer: There is some concern that the incidence of untoward events is higher in office-based surgery. Dr. Keyes, could you address that? Dr. Keyes: A recent study by the American Association for Accreditation of Ambulatory Surgery Facilities (AAAASF)1 demonstrates …