Some times you can survey events in our field and get an idea about the way things are likely to change in the future. Office-based plastic surgery is one of those things which I think is destined to become an endangered species.
A story like this in the Arizona Daily Star is one of those things that gets my wheels spinning. Last year a healthy well-known Tuscon, AZ lawyer died during an office based surgery from respiratory arrest. There was no salacious back story about either the Doctor or his clinic, it just happened. The office O.R. was accredited and a nurse anesthetist was present which both meet standards of care.
It only takes a few publicized instances of these case to really cause dramatic changes in the law. This already happened in Florida a few years ago and is likely to spread.
Why are so many cases done in the office? It's more convenient for patients and doctors and dramatically cheaper. Using a hospital or surgery center will nearly double the cost of many procedures. A less admirable reason for many providers who do office-based procedures is that they cannot get hospital privileges to do surgery. This is where Dermatologists, OBGYN's, and ENT/Facial Plastic Surgeons do liposuction, breast surgery, & other things they are arguably under trained to perform.
Again surveying the news I have no doubt that IV conscious sedation & general anesthesia will eventually become so heavily regulated that it makes it impractical to be done in the office and the pendulum swings back to doing all these procedures in the hospital again. I do a great deal of minor office surgery under local (biopsies, skin cancers, some skin grafts), but do major procedures in the hospital. It has less to do with feeling uncomfortable about office-surgery, but reflects my hesitancy to make a large capital investment for an accredited office OR when with the stoke of a pen I can no longer use it.
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