To the Editor
Concerning motives for the dramatic increase in office surgery, let us recall that ambulatory surgery centers were also originally developed for economic reasons and were opposed by hospitals on the same grounds now cited in opposition to office-based surgery. In my practice, the vast majority of office surgeries are minor cases on ASA class 1 and 2 . These patients are provided Level 2 anesthesia (MAC with regional blocks) with AANA and SOBA standards observed. The few Level 3 anesthesia cases (general or spinal) I’ve had, were in an office surgery suite better equipped than many rural hospitals in which I have worked. It had all policies and protocols in place with back up systems, etc.
If one is to practice office anesthesia, then you must verify all equipment, supplies, medications, policies, and protocols are in place at each office. If they are not, you must put them in place. This expertise is available from various professional organizations. Far from being criticized, Dr Laurito is to be commended for establishing a society to first create and then raise the level of standards for office-based anesthesia practice. Also the 3A’s, 4A’s and JCAHO have developed accrediting standards to insure patient safety. APSF has devoted an entire issue to office practice.
I believe most patients and surgeries are not candidates for office surgery or anesthesia. For the ones that are, the same procedure can be preformed in the office for about three thousand dollars less than in a hospital in this area. This benefits patients, insurance and yes, the surgeons and ourselves. If and when office surgery evolves through bureaucracy and over-regulation to the point it is no longer economic, then you will see surgery centers on Indian reservations and cruise ships. Offering a quality product or service at a reasonable price is an American tradition. When we forget that, we are forced to compete politically and then quality suffers while cost increases.
Ernest P. Ayo, DP, CRNA