Duration of anesthesia as an indicator of morbidity and mortality in office-based facial plastic surgery: a review of 1200 consecutive cases.

OBJECTIVE: To define whether duration of anesthesia is an indicator of patient morbidity and mortality in facial plastic surgery performed in an accredited office-based surgical facility. DESIGN: A prospective and retrospective outcomes analysis of 1200 consecutive patients who underwent facial plastic surgery from July 1995 to February 2005. Outcomes of patients who underwent surgery with anesthesia for less than 240 minutes were compared with those of patients who underwent surgery with anesthesia for more than 240 minutes. RESULTS: Of the 1200 cases analyzed, in 1032 (86%), duration of anesthesia was longer than 240 minutes. There were no deaths and no cases of myocardial infarction or pulmonary embolism in this study group. Morbidity in the 1200 cases was reported as follows: 1 case of respiratory failure, 1 case of central nervous system deficit, 1 case of adverse reaction to medication, and 1 case that required transfer to a hospital. There were 6 cases of prolonged recovery from anesthesia. Incidences of major morbidity in the group of 168 patients (14%) whose anesthesia lasted less than 240 minutes were the same as in the group whose anesthesia lasted more than 240 minutes. CONCLUSIONS: In an accredited office-based facial plastic surgery facility, anesthesia duration is not an indicator of patient morbidity and mortality. Combined facial plastic surgery procedures, using general anesthesia, can be accomplished safely in the office-based environment, and inpatient care would not have altered morbidity in this study group.

Office-based anesthesia: an overview.

Office-based anesthesia, like other specific forms of anesthesia practice, has many unique attributes. Better work hours and a closer working relationship with surgeons and patients can provide the forum for a considerable amount of professional resonance. Moreover, the itinerant nature of the practice, the limited resources, and the need to innovate on the spur of the moment can make for variety and excitement. The gamut of anesthesia techniques, patient comorbidities, and surgeon expectations does not necessarily produce a facile experience, of course. But no specific anesthesia specialty or venue is devoid of challenge. While OBA is different from other types of anesthesia practice, this distinction does not necessarily make it superior or inferior. The political climate has improved, with more states acknowledging the status of OBS and OBA. This may force those OBA providers who routinely practice without regard to practical and appropriate industry standards out of business. AAAHC accreditation of an OBA practice may serve as a confidence-inspiring indication to patients that nationwide peer-reviewed standards are being met. However, everyone involved must recognize that accreditation is not a substitute for the sound application of clinical knowledge and expertise, as well as the collection and assessment of quality assurance data. It is inappropriate to view each OBS client as a minihospital. Although this may seem a simpler business model, the business and legal issues can be far more complex than those found in more traditional locales. A meld between business-person and clinician is becoming more a rule than an exception, and efforts to maintain and promote professional sovereignty will help forge continued growth of this unique form of anesthesiology practice.