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Most office-based surgery centers unregulated

National report — While Jeff Pearcy, executive director of the American Association for Accreditation of Ambulatory Surgery Facilities (A.A.A.A.S.F.), believes that virtually all physicians are concerned about the health and welfare of their patients, he finds it "frightening" that in all but 14 states, the office-based surgery centers in which doctors are performing increasingly complex procedures are totally unregulated by the government.

"Although state legislatures have a requirement to protect their citizens, they seem to have no idea of the complexity of surgery performed in non-accredited office-based practices," he tells Cosmetic Surgery Times.

Mr. Pearcy says that only about 1,200 of the estimated 40,000 office-based surgery facilities in the United States are accredited by his organization.

Those numbers, he says, would surely be even lower were it not for the leadership of the states of California and Florida, which insist upon accreditation for all office-based facilities, and the main plastic surgery societies, the American Society of Plastic Surgeons and the American Society for Aesthetic Plastic Surgery, which require it for membership among physicians who practice in such facilities.

Safer facilities

The proliferation of office-based procedures — particularly in cosmetic surgery — underscores the importance of ensuring these procedures are performed as safely as possible, Mr. Pearcy says. To this end, he focuses on the main safety issues in offering three questions that patients should ask, starting with an inquiry about the quality of the practitioner.

"Is the surgeon practicing within the scope of his/her practice and with adequate training for the procedure planned?" he says.

"Is the facility itself safe, and are the right people in the operating room? Am I an appropriate candidate for this surgery in an office-based facility, as opposed to a hospital?"

Why accreditation?

The purpose of accreditation, Mr. Pearcy says, is to address that second question — issues pertaining to the safety of the facility itself and the qualifications of everyone in the operating room.

To be accredited as class A, B, C or C-M, depending primarily upon anesthesia use, facilities must meet specific requirements related to the following:

  • general environment; operating room environment and policies and procedures
  • recovery room environment and policies and procedures
  • general safety in the facility; blood and medications
  • medical records
  • quality assessment/ improvement
  • personnel
  • governance
  • anesthesia use, with Class C facilities accredited for the use of intravenous propofol, spinal or epidural anesthesia; endotracheal intubation or laryngeal mask airway; or inhalation anesthesia (including nitrous oxide).

Facilities must also comply with applicable local, state and federal regulations, and utilize advanced instruments and monitoring devices for patient safety during surgery and in the recovery period.

Additionally, only qualified surgeons who have privileges to perform the same surgical procedures in an accredited hospital can perform the procedure off-site.

These surgeons must be certified or admissible for certification by the American Board of Medical Specialties or the American Osteopathic Association Bureau of Osteopathic Specialists, or be podiatrists certified or admissible for certification by the American Board of Podiatric Surgery. They must also provide for the administration of general anesthesia, when appropriate, by a board-certified or board-eligible anesthesiologist or a certified registered nurse anesthetist.

Also subject to examination are the qualifications of other personnel assisting in surgery and providing care for the patient in the recovery room, including specially trained and certified surgical technicians, registered nurses and licensed practical nurses.


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