Hand, Shoulder Surgeries at OP Centers: Few Complications

Researchers have found that hand and shoulder surgeries performed at a freestanding, outpatient (OP) center resulted in few complications—0.2% in nearly 29, 000 patients over an 11-year period. The study, which took place at a freestanding ambulatory surgical center in Wexford, Pennsylvania, appears in the new issue of the Journal of Bone and Joint Surgery.

Despite the increase in outpatient procedures, “there remains a paucity of literature on safety, ” said lead study author, Kanu S. Goyal, M.D., an orthopedic surgeon at The Ohio State University Wexner Medical Center, in the April 21, 2016 news release.

In this study, researchers reviewed the outcomes of 28, 737 procedures performed from 2001 to 2012 at a center specializing in hand and upper extremity surgery.

As indicated in the news release, “Cases were reviewed for adverse events including post-operative infection requiring intravenous antibiotics or return to the operating room, post-operative transfer to a hospital, wrong-site surgery, surgical items left in the patient, post-operative deep vein thrombosis (VTE) or blood clots, medication error, and other complications related to surgery.”

“There were 58 reportable adverse events for an overall complication rate of 0.2 percent: 14 patients sustained an infection, 18 required transfer to a hospital for additional care, and 21 were admitted to the hospital after discharge from the surgical center. There was one medication error and four post-operative blood clots. There were no cases of wrong-site surgery, retained surgical items or death.”

Dr. Goyal told OTW, “Patient selection for outpatient surgery at a freestanding ambulatory surgery center is critical to achieving a low adverse event rate. Guidelines for patient appropriateness may vary from center to center—but most focus on patient risk factors—American Society of Anesthesiologist class, history of cardiac or lung disease, BMI [body mass index], and history of infection, to name just a few. Some of these risk factors place the patient at risk of complication, whereas some place other patients being cared for at risk for complications (e.g., infection). Finally, the planned operation, complexity, duration and expected anesthesia are also important factors when deciding appropriateness for outpatient surgery at a freestanding center.”

“In general, achieving a low adverse event rate boils down to great patient care in the setting of low risk procedures in low risk patients. In our opinion, if there is any concern for patient safety preoperatively, then consideration for performing the operation in a hospital setting should be given—even if the estimated risk of adverse event is low.”