Accreditation Of Ambulatory Surgery Facilities Research Articles

Liposuction Complications in the Outpatient Setting: A National Analysis of 246,119 Cases in Accredited Ambulatory Surgery Facilities.

Suction lipectomy (liposuction) is a popular cosmetic surgical procedure performed in the United States, but little has been documented regarding perioperative complications due to its outpatient nature. This cross-sectional study aims to analyze the most common complications that accompany liposuction-related procedures and importantly estimate the total complication rate occurring at ambulatory surgical facilities. Adult patients who experienced liposuction-related complications from 2019 to 2021 were identified in the reporting database of the global surgery accreditation authority, the American Association for Accreditation of Ambulatory Surgery Facilities (QUAD A). Patients were then divided by complication type and procedure location. Demographics and facility-specific variables were analyzed. Descriptive statistics were performed. Overall, 984 patients were included, with a mean age of 44 years (interquartile range [IQR] 37-53) and a median BMI of 28.7 kg/m2 (IQR 25.7-32.2). The overall confirmed complication rate was found to be 0.40% (984/246,119). Unplanned emergency department presentation was the most common complication overall (24%). Wound disruption was associated with the longest median procedure length (261 min), and venous thromboembolism was associated with the highest median BMI (30.1 kg/m2). The Southeast had the most complications (431), which accounted for 13/21 deaths (61.9%). Out of all complications, death was associated with the highest average annual case volume (241). Procedures that involve liposuction are associated with a variety of medical and surgical complications. Given the high frequency and variability in how liposuction is performed, a thorough assessment of complications is critical to improve the safety of this procedure.

Complications From Fat Grafting and Gluteal Augmentation in Outpatient Plastic Surgery: An Analysis of American Association for Accreditation of Ambulatory Surgery Facilities (AAAASF, QUAD A) Data.

Gluteal augmentation with autologous fat grafting, colloquially referred to as Brazilian butt lift (BBL), is an increasingly common procedure with a highly reported complication profile. In this study we aimed to analyze the prevalence and characteristics of complications that accompanied these surgeries at ambulatory surgery facilities. Adults patients who experienced fat grafting complications from 2019 to 2021 were identified in QUAD A, formerly known as the American Association for Accreditation of Ambulatory Surgery Facilities (AAAASF, Highland Park, IL, USA), database. Patients and complications were analyzed based on sociodemographic, surgery-, and facility-specific variables with descriptive statistics and logistic regression. Overall, 436 fat grafting procedures with complications were reported to QUAD A, with an overall complication rate of 0.94%. Of these complications, 164 (37.6%) were confirmed to be from gluteal augmentation procedures. Notably, the number of gluteal augmentation with fat grafting complications decreased from the year 2019 (48) to 2020 (36), then nearly doubled from 2020 to 2021 (69). The majority of patients were female (96.7%), with a mean age of 42.0 years and a mean BMI of 28.3 kg/m2. Wound infection was the most commonly documented complication (22.3%). Of the patients who experienced complications, 35.9% presented to a hospital for their complications and 12.6% required reoperation. Four deaths were described. There was no association between sociodemographic or surgical variables and increased odds of readmission or reoperation (P > .05), except for increasing surgeon number and reoperation (P = .02). Gluteal augmentation accounts for a large proportion of complications from fat grafting procedures. Increased reporting requirements may aid in future determination of incidences of complications and improve patient safety.

79. Liposuction Complications Reporting Occurring in Ambulatory Surgery Centers: An Analysis of the American Association For Accreditation of Ambulatory Surgery Facilities (AAAASF) Patient Safety Data Reporting From 2019-2021

79. Liposuction Complications Reporting Occurring in Ambulatory Surgery Centers: An Analysis of the American Association For Accreditation of Ambulatory Surgery Facilities (AAAASF) Patient Safety Data Reporting From 2019-2021

12. Liposuction Complications Reporting Occurring in Ambulatory Surgery Centers: An Analysis of the American Association for Accreditation of Ambulatory Surgery Facilities (AAAASF) Patient Safety Data Reporting from 2019-2021

12. Liposuction Complications Reporting Occurring in Ambulatory Surgery Centers: An Analysis of the American Association for Accreditation of Ambulatory Surgery Facilities (AAAASF) Patient Safety Data Reporting from 2019-2021

Stanley A. Klatsky, M.D., 1934 to 2020.

Stanley A. Klatsky, M.D., 1934 to 2020.

Evaluating Facelift Complications and the Effectiveness of the SMASectomy Technique: A Single Center's 15-Year Experience.

BackgroundFacelift continues to be one of the most common aesthetic procedures performed in the United States. Although there exist many techniques and variations, superficial musculoaponeurotic system (SMAS) manipulation, by way of plication, overlap, or SMASectomy, is common and has been shown to result in favorable cosmesis and durability. However, there is a lack of current complications data in the discussion of this technique.ObjectivesTo assess the benefits and risks of the SMASectomy technique.MethodsThe records of all patients who underwent a facelift procedure between December 2004 and March 2019 were reviewed for this study. All procedures were performed at an American Association for Accreditation of Ambulatory Surgery Facilities (AAAASF)-accredited outpatient facility in Marina Del Rey, California. This represents data on 241 total patients. Retrospective chart review was performed to include data on patient characteristics, operative technique, and complications.ResultsAverage operative time of 152.68 ± 51.50 minutes and anesthesia time of 175.00 ± 54.07 minutes were observed among those patients who underwent SMASectomy. This was significantly lower (P < 0.000001) than those who did not undergo SMASectomy (average operative time of 265.25 ± 85.25 minutes and anesthesia time of 294.22 ± 85.31 minutes). There were no observed facial nerve injuries among patients who underwent SMASectomy. No deep vein thrombosis (DVT) events were observed in this patient population. ConclusionsIn the hands of an experienced surgeon, the SMASectomy facelift technique offers the unique advantage of significantly reducing operating time and anesthesia time and can provide extremely favorable and long-lasting aesthetic results.Level of Evidence: 3

Ambulatory Anesthesia, An Issue of Anesthesiology Clinics, Volume 37, Number 2

Ambulatory Anesthesia, An Issue of Anesthesiology Clinics, Volume 37, Number 2

American Association for Accreditation of Ambulatory Surgical Facilities (AAAASF) History: Its Role in Plastic Surgery Safety.

From its origin cosmetic surgery was performed in facilities which were neither certified nor regulated. Recognizing that there was no formal oversight of facilities, a group of plastic surgeons saw the need to develop an accreditation program. This eventually evolved into the American Association for Accreditation of Ambulatory Plastic Surgery Facilities. The organization was started to implement and maintain a voluntary inspection accreditation program for qualifying surgical facilities. Its focus was to educate plastic surgeons on safety and became recognized as the gold standard for accreditation. Seeing the need for similar standards for all surgeons, it morphed into the American Association for Accreditation of Ambulatory Surgery Facilities (AAAASF). Comprehending that accreditation was in everyone’s best interest, AAAASF developed educational formats for plastic surgeons, testified at the US Congress suggesting potential ways that oversight of facilities could improve patient safety, functioned as a resource to numerous states in developing guidelines for oversight of facilities, continued to update its standards, and extended its accreditation program internationally. Recognizing the value of accreditation, proven by AAAAASF’s extensive database from its Internet-Based Quality Assurance Program, the American Society for Aesthetic Plastic Surgery (ASAPS) and the American Society of Plastic Surgeons (ASPS) mandated that its members operate only in accredited or licensed facilities. Numerous studies documenting the safety of accredited plastic surgical facilities from AAAASF’s extensive quality assurance and peer-review reporting program are cited. AAAASF played a significant role and will continue to do that in producing better, safer environments for outpatient surgical procedures.

Commentary on: Liver Trauma During Combined Liposuction and Abdominoplasty: A Rare but Potentially Lethal Complication.

In the case report entitled “Liver Trauma During Combined Liposuction and Abdominoplasty: A Rare but Potentially Lethal Complication,” the authors discuss the occurrence of an intra-abdominal penetration with liver trauma during the combined surgical procedures of abdominoplasty and liposuction on a 38-year-old woman.1 They note that while liposuction is a well-established procedure that is generally safe, complications do rarely occur. A review of the data acquired through the American Association for Accreditation of Ambulatory Surgery Facilities (AAAASF) Internet Based Quality Assurance and Peer Review (IBQAP) reporting system from 2001 through 2013 substantiates a low incidence of sequelae associated with liposuction alone. A total of 1,034,414 procedures were evaluated. Liposuction was the sole procedure in 399,292 …

Spine Surgery in an Ambulatory Setting: What Can Be Done Safely?

The first ambulatory surgery center was established in 1970 in Phoenix, Arizona by two surgeons with a vision of providing more convenient surgical services to their community. Twelve years later, Medicare approved the first payments to ambulatory surgery centers, sparking an era of substantial growth. By 1988, there were 1000 ambulatory surgery centers in the United States, and today more than 23 million procedures are performed yearly at 5300 ambulatory surgery centers1. Because ambulatory surgery centers are delivering health care to patients, they require accreditation similar to traditional hospitals; however, while they can be accredited by The Joint Commission (http://www.jointcommission.org/) or the Healthcare Facilities Accreditation Program (HFAP) (http://www.hfap.org/) as can traditional hospitals, they also may be accredited by ambulatory surgery center-specific firms such as the American Association for Accreditation of Ambulatory Surgery Facilities (AAAASF) (http://www.aaaasf.org/) or the Accreditation Association for Ambulatory Health …

Assessing patient safety in Canadian ambulatory surgery facilities: A national survey

Background There has been increased interest regarding patient safety and standards of care in Canadian ambulatory surgery facilities where surgical procedures are performed. The Canadian Association for Accreditation of Ambulatory Surgical Facilities (CAAASF) is a national organization formed to establish and maintain standards to ensure that surgical procedures conducted outside of public hospitals are performed safely. Objective To determine how many procedures are performed annually at CAAASF member sites, and to examine complication rates and several key patient safety practices. Methods All 69 facilities accredited by the CAAASF were surveyed. The survey focused on procedural data, complication rates and patient safety interventions. Results In 2010, 40,240 estimated procedures were performed. A total of 263 (0.007%) complications were reported. Sixteen (0.0004%) patients required reoperations in hospital and 19 (0.0004%) patients required transfer to hospital on the day of surgery. There were only two mortalities within 30 days of surgery reported in the past five years. With regard to patient safety practices, 93% used antimicrobial prophylaxis, 100% used strategies to maintain normothermia and 82% used measures for venous thromboembolism prevention. Conclusion The present study is the first to report on the Canadian experience in ambulatory surgery facilities and provides insight into current practices at these facilities. Appropriate accreditation of ambulatory surgery facilities, well-established patient safety-related standards of care, careful patient selection and procedures performed by qualified health care professionals with appropriate certification practicing within the scope of their practice form the basis for safe and effective ambulatory surgery.

Assessing patient safety in Canadian ambulatory surgery facilities: A national survey

There has been increased interest regarding patient safety and standards of care in Canadian ambulatory surgery facilities where surgical procedures are performed. The Canadian Association for Accreditation of Ambulatory Surgical Facilities (CAAASF) is a national organization formed to establish and maintain standards to ensure that surgical procedures conducted outside of public hospitals are performed safely. To determine how many procedures are performed annually at CAAASF member sites, and to examine complication rates and several key patient safety practices. All 69 facilities accredited by the CAAASF were surveyed. The survey focused on procedural data, complication rates and patient safety interventions. In 2010, 40,240 estimated procedures were performed. A total of 263 (0.007%) complications were reported. Sixteen (0.0004%) patients required reoperations in hospital and 19 (0.0004%) patients required transfer to hospital on the day of surgery. There were only two mortalities within 30 days of surgery reported in the past five years. With regard to patient safety practices, 93% used antimicrobial prophylaxis, 100% used strategies to maintain normothermia and 82% used measures for venous thromboembolism prevention. The present study is the first to report on the Canadian experience in ambulatory surgery facilities and provides insight into current practices at these facilities. Appropriate accreditation of ambulatory surgery facilities, well-established patient safety-related standards of care, careful patient selection and procedures performed by qualified health care professionals with appropriate certification practicing within the scope of their practice form the basis for safe and effective ambulatory surgery.

Progressive Tension Sutures in Abdominoplasty: A Review of 597 Consecutive Cases

Although abdominoplasty and other body-contouring procedures are being performed more frequently, the incidence of seroma and other complications has remained relatively unchanged. In 2000, a small retrospective series introduced progressive tension sutures (PTS) in abdominoplasty to reduce seroma without the use of drains. The authors review the PTS technique and their experience with the procedure. A retrospective chart review of 597 consecutive abdominoplasty patients treated over 12 years was performed. Collected data included surgical setting, concomitant procedures, and complications. Of the 597 abdominoplasties, 52.4% were performed in the hospital and 47.6% in an American Association for Accreditation of Ambulatory Surgery Facilities (AAAASF)-accredited facility. In 63.7% of cases, abdominoplasty was combined with another procedure(s). Liposuction was performed on the abdominoplasty flap or an adjacent area to the abdominoplasty dissection in 67% of patients. The average amount fat aspirate from these areas was 953 mL. No drains were placed. The rate of local complications was 4.2%; all but one of these complications (seroma; 0.1%) were minor. There were no systemic complications related to PTS and no venous thromboembolisms. PTS are an adjunct to abdominoplasty that can minimize seroma and potentially decrease other local complications. They provide secure fixation of the flap to eliminate motion and broadly transfer tension to the superficial fascial system. Drains can safely be eliminated from abdominoplasty, even when liposuction is performed. Systemic complications may be avoided and patient recovery expedited.

Commentary on: Breast Augmentation and Augmentation-Mastopexy With Local Anesthesia and Intravenous Sedation

In their article “Breast Augmentation and Augmentation-Mastopexy With Local Anesthesia and Intravenous Sedation,” Drs. Colque and Eisemann have provided us with a retrospective review of 171 patients who underwent bilateral breast augmentation or augmentation-mastopexy from January 1, 2007, to October 30, 2009. All these procedures were performed in a facility accredited by the American Association for Accreditation of Ambulatory Surgery Facilities (AAAASF). The anesthetic approach employed by the authors entails intravenous sedation with midazolam, fentanyl, and ketamine, and the procedure is directed by the operating surgeon and administered by a nurse. Intercostal nerve blocks injected into intercostal spaces 3-7 at the midaxillary line and the lateral sternal border provide a lateral and medial block to the breast tissue. The authors inject a mixture of 0.25% bupivacaine and 1% lidocaine, equally mixed, with an average dose of 79.6 mL. In the report, Drs. Colque and Eisemann emphasize that their approach differs from other techniques reported in the literature, including those that rely on propofol.1–5 AAAASF standards require an anesthesiologist or nurse anesthetist to be present when propofol is administered, but intravenous ketamine may be used at the discretion of the operating surgeon. The authors reported a decrease in the occurrence of postoperative nausea and vomiting (PONV), length of stay in the recovery room, and postoperative bleeding. They did not discuss the …

How Will Accreditation of Your Ambulatory Endoscopy Center Be an Essential Component of Showing Value-Based Health Care?

How Will Accreditation of Your Ambulatory Endoscopy Center Be an Essential Component of Showing Value-Based Health Care?

Surgery Facilities Resources, Inc./AAAASFI Expands International Accreditation into New Markets

Surgery Facilities Resources, Inc. (SFR) is a subsidiary organization to the American Association for Accreditation of Ambulatory Surgery Facilities (AAAASF), the “gold standard” for surgery facility accreditation in the United States. Organized in 2005, SFR was created to offer a program of accreditation internationally. In 2009, the SFR international accreditation program was renamed AAAASFI (AAAASF International) by the SFR board of directors. The AAAASFI name best represents who SFR is in international accreditation. Latin America countries have a significant interest in accreditation, especially Costa Rica. Currently, 40 AAAASFI accredited surgery facilities exist worldwide, as represented by Belgium, Serbia, South Africa, Australia, Finland, and Costa Rica. For a complete list of AAAASFI-accredited facilities, visit http://www.surgeryfacility.com. Past SFR President Michael McGuire and current SFR President Ronald Iverson, MD have championed this program of international accreditation for the past 5 years by speaking at many prestigious global conferences on health care and medical tourism and inspecting surgery facilities around the world. Recently, Jeff Pearcy, Executive Vice President, attended the Latin America Congress on Medical Tourism in Costa Rica and spoke on a panel discussing accreditation and patient safety. Dr. Geoffrey Keyes, AAAASF Secretary/Treasurer, was a keynote presenter on the second day of the Congress, presenting the latest study derived from the AAAASF peer review system data. It was the only data-driven presentation in the Congress. The President of Pro-Med, an international medical group and a leader in the movement to create a safe environment for medical tourism in Costa Rica, praised Dr. Keyes’ presentation. Representatives from Guatemala are in the process of working with Mr. Oscar Molina, the AAAASFI Latin American representative working for SFR, to discuss the development of an accreditation program that mirrors the successful program in Costa Rica. Many major Guatemalan dental facilities have received our application materials in anticipation of accreditation. A special set of dental standards has been developed by AAAASFI that more closely relate to surgical practices performed in dental clinics. Representatives from the Dominican Republic, El Salvador, and Columbia government agencies have received our accreditation program materials and have requested that we contact them for future development. A key contact for AAAASFI is Carlos Enrique Cardenas Rendon, director of a cluster of services for surgery and dentistry in Columbia. The benefits of global accreditation for plastic surgeons include the following: International practice of medicine: Aesthetic surgery has no true borders. It is becoming common practice for people to seek their aesthetic surgery in many different countries. Regardless of the motivation for this trend, one thing is constant: People want to be certain that they are receiving care in a safe facility. International accreditation gives them that assurance. Market advantage: Every country has individuals from a variety of surgical disciplines who currently offer aesthetic surgery. These people often qualify for their national or provincial license but may have only limited training and education in plastic surgery. The SFR/AAAASFI accreditation for aesthetic surgery is an effective tool for separating your practice from those of lesser quality. Assurance to patients: The certificate of accreditation is a symbol to patients that the accredited facility has taken the additional step of opening its practice to the scrutiny of an international organization dedicated to patient safety. This could be a deciding factor for patients seeking the highest-quality results in the safest environments. Dr. Ronald Iverson, President of SFR, has said, “This is truly a golden opportunity for any plastic surgeon to be recognized as a leader in his/her profession and to demonstrate to potential patients that he/she has taken every possible precaution for their safety. With the increased activity in medical tourism, now is the time to get involved in this international patient safety program of inspection and accreditation to help improve patient safety and quality care globally.”

Office-Based Anesthesia: Dispelling Common Myths

Running parallel with-and perhaps driven by-the huge increase in demand for cosmetic surgery, office-based anesthesia (OBA) is the fastest growing segment of anesthesia practice. Despite this, only 2% of anesthesiology residencies provide exposure to OBA, and many practicing anesthesiologists are not convinced that OBA techniques provide safe, reliable, and effective anesthesia care. To examine OBA techniques and safety records while addressing some of the commonly held beliefs among anesthesiologists regarding OBA. A review of 4800 patients undergoing 5264 cosmetic surgical procedures performed between 1997 and 2007 at Dudley Street Operatory (licensed in Rhode Island as a Physician Office Setting Providing Surgical Treatment and certified by the American Association for Accreditation of Ambulatory Surgery Facilities) was conducted. The primary anesthetic technique was deep sedation with a propofol ketamine infusion, combined with local anesthetic injection. Intercostal nerve blocks were performed before surgery in patients who had breast surgery and/or abdominoplasty. Endotracheal or laryngeal mask airway techniques were not used, nor were paralyzing agents, anesthetic gases, or vapors. There were 16 unanticipated postoperative admissions in 10 years, all but 3 from surgical complications (hematoma, infection, and pneumothorax during dissection for breast implants). One patient had an acute reaction to a small volume of local anesthetic injected into the nasal septum, one patient with a history of panic attacks had an acute anxiety attack manifested as chest pain, and one patient refused discharge from the operatory to home after a face lift, despite meeting postanesthesia care unit discharge criteria, and was admitted overnight to the hospital. There were no hospital admissions because of pain, nausea, or excessive sedation. In experienced hands, OBA techniques deliver an anesthetic for office-based cosmetic surgery superior to the usual general anesthesia performed in hospitals and ambulatory surgical centers. These techniques are safe, do not require expensive equipment other than an infusion pump and vital signs monitor, avoid sore throats and nausea, provide postoperative analgesia, and are well received by patients and surgeons. OBA presents an opportunity for anesthesiologists and aesthetic surgeons to partner for greater patient satisfaction.

Mortality in Outpatient Surgery

The American Association for Accreditation of Ambulatory Surgery Facilities (AAAASF) has reported statistics on morbidity and mortality for facilities that it accredits based on an analysis of unanticipated sequelae and surgical mortality. Data acquired through the first Internet-Based Quality Assurance and Peer Review reporting system (IBQAP) were reviewed and published in 2004. This article reports the accumulated data in the IBQAP through June of 2006, analyzing death associated with procedures performed in facilities approved by the AAAASF. With the exception of some statistics on the Medicare-aged population, there are few data reported in the literature related to deaths in outpatient surgery. The IBQAP, designed in 1999 by the AAAASF, mandates biannual reporting of all unanticipated sequelae and random case reviews by all surgeons operating in AAAASF-accredited facilities. Surgical log numbers, whose entry is required, allow for tabulation of the number of cases and procedures performed by individual reporting surgeons. In this review of data collected using the IBQAP from January of 2001 through June of 2006, there were 23 deaths in 1,141,418 outpatient procedures performed. Pulmonary embolism caused 13 of the 23 deaths. Only one death occurred as the result of an intraoperative adverse event. A pulmonary embolism may occur after any operative procedure, whether it is performed in a hospital, an ambulatory surgery center, or a physician's office-based surgery facility. The procedure most commonly associated with death from pulmonary embolism in an office-based surgery facility is abdominoplasty. The frequency of pulmonary embolism associated with abdominoplasty warrants further study to determine predisposing factors, understand its cause, and introduce guidelines to prevent its occurrence.

American Association for Accreditation of Ambulatory Surgery Facilities

American Association for Accreditation of Ambulatory Surgery Facilities

Certification for Office-Based Plastic Surgery

Office-based and freestanding ambulatory surgical facilities have become commonplace and the surgeries they perform more elaborate. Accreditation of all outpatient surgical facilities is necessary to maintain a standard of care that safeguards the patient and reduces liability for the physician. The accreditation entities that currently dominate the industry include JCAHO (Joint Commission for Accreditation of Hospital Organizations), the American Osteopathic Association's HFAP (Healthcare Facilities Accreditation Program), and AAAASF (American Association for Accreditation of Ambulatory Surgery Facilities). All of these accrediting bodies provide standards of operation that maintain a level of care and improve patient safety. We will examine the impact of certification in the safe operation of outpatient surgical facilities.