Safety and efficacy of office-based surgery with monitored anesthesia care/sedation in 4778 consecutive plastic surgery procedures

Office-based surgery has several potential benefits over hospital-based surgery, including cost containment, ease of scheduling, and convenience to both patients and surgeons. Scrutiny of office-based surgery by regulators and state-licensing agencies has increased and must be addressed by improved documentation of safety and efficacy. To evaluate the safety and efficacy of the authors' office-based plastic surgery, a review was undertaken of 3615 consecutive patients undergoing 4778 outpatient plastic surgery procedures under monitored anesthesia care/sedation in a single office. The charts of 3615 consecutive patients who had undergone office-based surgery with monitored anesthesia care/sedation between May of 1995 and May of 2000 were reviewed. In all cases, the anesthesia protocol used included sedation with midazolam, propofol, and a narcotic administered by a board-certified registered nurse anesthetist with local anesthesia provided by the surgeon. Charts were reviewed for patient profile, types of procedures, multiple procedures, duration of anesthesia, American Society of Anesthesiologists class, and complications related to anesthesia. Outcomes measured included death, airway compromise, dyspnea, hypotension, venous thrombosis, pulmonary emboli, protracted nausea and vomiting lasting more than 24 hours, and unplanned hospital admissions. Statistical analyses were performed using the Microsoft Excel program and the SAS package. Results were as follows: 92.3 percent of the patients were female and 7.7 percent were male, with a mean age of 42.7 years (range, 3 to 83 years). Patients underwent aesthetic (95.6 percent) and reconstructive (4.4 percent) plastic surgery procedures. Same-session multiple procedures occurred in 24.8 percent of patients. The vast majority of patients were healthy: 84.3 percent of patients were American Society of Anesthesiologists class I, 15.6 percent were class II, and 0.1 percent were class III. The operations required a mean of 111 minutes. There were no deaths, ventilator requirements, deep venous thromboses, or pulmonary emboli. Complications were as follows: 0.05 percent (n = 2) of patients had dyspnea that resolved, 0.2 percent (n = 6) of patients had protracted nausea and vomiting, and 0.05 percent (n = 2) of patients had unplanned hospital admissions (<24 hours). One patient had an emergent intubation. No prolonged adverse effects were noted. There was a 30-day follow-up minimum. Outpatient surgery is an important aspect of plastic surgery. It was shown that office-based surgery with intravenous sedation, performed by board-certified plastic surgeons and nurse anesthetists, is safe. Appropriate accreditation, safe anesthesia protocols, and proper patient selection constitute the basis for safe and efficacious office-based outpatient plastic surgery.     

General anesthesia in an office-based plastic surgical facility: a report on more than 23,000 consecutive office-based procedures under general anesthesia with no significant anesthetic complications

The popularity of elective office-based plastic surgery has increased significantly over the past two decades. The continuing demand for improved aesthetic results has stimulated the development of ever more complex plastic surgical techniques. These techniques may require extended periods of operative time spent under anesthesia. Patients have come to expect an almost perfect anesthetic and surgical experience, with safety and comfort being their foremost concerns. Because of increasingly complex and lengthy operations, the authors believe that intravenous sedation, used for many years in their plastic surgery practice, is now suboptimal for most longer and complex surgical procedures. In their experience, under most circumstances, general anesthesia provides the optimal anesthetic experience for the patient, anesthesiologist, and surgeon. The authors present a consecutive 18-year study of general anesthesia in more than 23,000 procedures in an accredited, office-based plastic surgical facility that offers a very safe and uniformly pleasant anesthesia experience for patients. There were no intraoperative or postoperative deaths and no significant complications. The authors' experience differs from the common perception that general anesthesia is too risky for aesthetic surgery procedures.     

Accuracy of office-based immunoassays for the diagnosis of Helicobacter pylori infection in children

Background. Rapid non‐invasive diagnostic tests that can reliably document the presence or absence of Helicobacter pylori infection are urgently required. The aim of this study was to determine the accuracy of two immunoassays (Flex‐Sure and MedMira), developed for use outside the laboratory setting by practitioners, in the setting of a low prevalence of H. pylori infection. Methods. Serum samples collected in four previous studies (n = 349) were employed to detect the presence of H. pylori‐specific immunoglobulin G, compared to previous results obtained using endoscopic biopsies, serology, flow cytometry, and urease breath testing. Serum samples included 52 obtained from adults (parents and grandparents of symptomatic children), 123 sera collected from children and adolescents undergoing diagnostic upper endoscopy for upper gastrointestinal tract symptoms, and 174 samples drawn from children in the primary care setting with or without recurrent abdominal pain. Results. Overall, 16% of subjects were infected by the gastric pathogen. Both the specificity (%) and negative predictive value (%) of the two tests were high (FlexSure: 91 and 92; Medmira: 97 and 94, respectively). In adults, both tests also demonstrated high sensitivity (83% and 86%) and positive predictive values (79% and 83%, respectively). However, in children where the prevalence of infection was 12% (37 of 297 subjects), the sensitivity (59% and 71%) and positive predictive values (55% and 88%, respectively) of the immunoassays were lower. Conclusions. These findings indicate that, in the setting of a low prevalence of H. pylori infection, the MedMira office‐based test provides satisfactory results and utility. However, the low positive–predictive value of the FlexSure kit may limit applicability of this test in children.