Circulation 60,475 • Volume 15, No. 1 • Spring 2000

SPECIAL ISSUE: OBA Safety Office-Based Anesthesia Growth Provokes Safety Fears

Robert K. Stoelting, MD

This issue of the Anesthesia Patient Safety Foundation (APSF) Newsletter is devoted to Office-Based Anesthesia (OBA), which has rapidly become the fastest growing venue for the delivery of anesthesia outside the traditional hospital-based operating room. The inducement for performing surgery in a physician’s office is the cost-saving (low overhead) potential as well as control of the schedule and also patient convenience and satisfaction. OBA has been facilitated by the introduction of short-acting anesthetic drugs that are associated with minimum side effects and which usually permit a rapid awakening and recovery.

APSF is concerned that the explosive expansion in OBA for an increasing number and variety of surgical procedures has occurred without appropriate considerations for patient safety. Newspaper reports and television documentaries have detailed tragic and clearly avoidable adverse incidents occurring during anesthesia and surgery in the physician’s office. Of note, almost all of these tragedies involve anesthesia-related events.

It is inconsistent and illogical to perform an anesthetic for a surgical operation in a physician’s office without having the same resources (personnel, equipment, monitors, drugs, facilities, administrative policies) that would be present (and are required for accreditation) should the same surgical procedure be performed in a hospital or ambulatory surgery facility. Sound reasoning and logic dictates that patients should receive the same level of anesthetic care regardless of the setting in which the surgery is performed. Patients need to know that a single safety standard applies regardless of whether anesthesia is delivered in a physician’s office, hospital, or ambulatory surgery facility. At present, OBA too often represents an “unregulated environment” which lacks the infrastructure and safety net inherent in hospitals and ambulatory surgery facilities.

APSF is committed to the goal that “no patient shall be harmed by anesthesia.” At present, this goal seems to be elusive at best with respect to OBA. It is the hope of APSF that this special issue of the APSF Newsletter devoted to OBA will serve as the “rallying point” for all those involved in OBA and office-based surgery (patients, providers, industry, insurance companies, accreditation agencies) to exert a maximum effort to optimize patient safety during OBA. In this regard, increased public awareness of anesthesia patient safety issues may be one of the most important determinants for improving anesthesia patient safety during OBA.

Dr. Stoelting, Chairman of Anesthesiology at Indiana University, Indianapolis, is President of the Anesthesia Patient Safety Foundation.