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Mortality in Outpatient Surgery

Keyes, Geoffrey R. M.D.; Singer, Robert M.D.; Iverson, Ronald E. M.D.; McGuire, Michael M.D.; Yates, James M.D.; Gold, Alan M.D.; Reed, Larry M.D.; Pollack, Harlan M.D.; Thompson, Dennis M.D.

Plastic and Reconstructive Surgery: July 2008 - Volume 122 - Issue 1 - p 245-250
doi: 10.1097/PRS.0b013e31817747fd

Background: The American Association for Accreditation of Ambulatory Surgery Facilities (AAAASF) has reported statistics on morbidity and mortality for facilities that it accredits based on an analysis of unanticipated sequelae and surgical mortality. Data acquired through the first Internet-Based Quality Assurance and Peer Review reporting system (IBQAP) were reviewed and published in 2004. This article reports the accumulated data in the IBQAP through June of 2006, analyzing death associated with procedures performed in facilities approved by the AAAASF. With the exception of some statistics on the Medicare-aged population, there are few data reported in the literature related to deaths in outpatient surgery.

Methods: The IBQAP, designed in 1999 by the AAAASF, mandates biannual reporting of all unanticipated sequelae and random case reviews by all surgeons operating in AAAASF–accredited facilities. Surgical log numbers, whose entry is required, allow for tabulation of the number of cases and procedures performed by individual reporting surgeons.

Results: In this review of data collected using the IBQAP from January of 2001 through June of 2006, there were 23 deaths in 1,141,418 outpatient procedures performed. Pulmonary embolism caused 13 of the 23 deaths. Only one death occurred as the result of an intraoperative adverse event.

Conclusions: A pulmonary embolism may occur after any operative procedure, whether it is performed in a hospital, an ambulatory surgery center, or a physician’s office-based surgery facility. The procedure most commonly associated with death from pulmonary embolism in an office-based surgery facility is abdominoplasty. The frequency of pulmonary embolism associated with abdominoplasty warrants further study to determine predisposing factors, understand its cause, and introduce guidelines to prevent its occurrence.

Los Angeles, La Jolla, and Stanford, Calif.; Camp Hill, Pa.; New York, N.Y.; and Dallas, Texas

From the University of Southern California, Stanford University Medical School, and the University of California, Los Angeles; Holy Spirit Hospital; Weill Cornell Medical College; and the University of Texas Southwestern Medical School.

Received for publication November 12, 2007; accepted January 7, 2008.

Geoffrey R. Keyes, M.D.; Keyes Surgery Center; 9201 West Sunset Boulevard, Suite 611; Los Angeles, Calif. 90069;

Disclosure: None of the authors has a financial interest in any of the products, devices, or drugs mentioned in this article.

©2008American Society of Plastic Surgeons