Tuesday May 22 5:20 PM ET

Office-Based Surgery Safe, Except Some Liposuctions

By Amy NortonNEW YORK (Reuters Health) - Despite fears in some corners that surgery performed in doctors' offices is fraught with danger, new research indicates that for the most part such procedures pose no greater risk than those performed in hospitals. The one exception, however, may be for liposuction performed while patients are completely knocked out with anesthesia.``There's been all this talk about renegade doctors performing office-based procedures because they don't have hospital privileges,'' Dr. Brett Coldiron of the University of Cincinnati, Ohio, told Reuters Health. ``But that just isn't the case.''In a review of incident reports in Florida,

Coldiron found that serious complications from office-based surgery were infrequent and nearly all of the doctors involved were fully qualified and equipped to perform the procedures. He reports the findings in the May 23/30 issue of The Journal of the American Medical Association (news - web sites ).In 2000, there were 31 reports of procedure-related incidents involving 28 Florida doctors, Coldiron found. Among the six deaths were three patients who had undergone liposuction while under general anesthesia.And while Coldiron said the Florida data show office-based procedures are largely safe, he added that the one problem may be with liposuction performed under general anesthesia.``It would appear that liposuction with general anesthesia is more dangerous,'' Coldiron said, noting that this trend needs further investigation.There were no deaths linked to any type of procedure done under local anesthesia. It is unclear, however, why general anesthesia paired with liposuction presented the most significant risk in this study, according to Coldiron.Many liposuction-related deaths have been attributed to blood clots that form during the procedure and then travel to the lungs.

Other risks include the volume of fat removed and the type of anesthesia. Earlier this month, researchers reported that between 1998 and 2000, the death rate from liposuction was 1 in 47,500 procedures.In this study, Coldiron noted, the data indicate that the doctors' skills were not to blame for any in-office incidents. All but one doctor who reported an incident was a board-certified specialist and had hospital privileges. And an anesthesiologist or nurse anesthetist sedated the patients in all general-anesthesia procedures.In August, Florida banned the use of general anesthesia in offices, Coldiron notes in his report.Only a few states require doctors to report deaths and complications that occur during and shortly after an office-based procedure.

Florida issued its law in 2000, and more states are likely to follow, Coldiron said.This first set of statistics on in-office procedures should be ``reassuring,'' he said. Other than the liposuction numbers, according to Coldiron, ``all in all, the data show that the terrible fears about office procedures were unfounded.''SOURCE: The Journal of the American Medical Association 2001;285:2582.