Surgical suite (in doctors office) vs hospital

 Thank you Shelly ....

Last week I had upper eyes, face, and neck surgery done in my surgeon's accredited hospital suite. Doing great! The end of the month I get bl/ba and arms done. Will then plan a Lbl too and perhaps thighs. He is a fabulous surgeon, there is a hospital nearby, he will not operate longer than 6 hrs, and all procedures are outpatient. Hopefully you will do just great! Being a bit nervous about surgery is understandable.

I had breast impants and a tummy tuck at my surgeons office and then stayed overnight in a hotel nearby as I live 3 hours away.  Then stopped by the office next day so he could make sure everything was alright before heading home.

Let me clarify my bias before you read on: I am a fanatical patient safety nut.  I dream about it.  I worry about it.  I ask myself, if something happens will I be prepared.  I have a 3-day supply of food in the house now that it's hurrican season down here.  And an evacualtion plan. Guns and ammo...well, not so much ! OK, that's just me.
 
A surgical center is probably fine for most patients as long as it is staffed, equipped. and accredited. The doctor should have admitting priviliges at a hospital that is close by too. A thorough medical history, evaluation of any problems, and referral to a specialist shouyld be done as needed.

Thousands of cases are done safely every year in these centers, although most are smaller cases. 

Tummy tuck and especially body lift are two of the largest and longest procedures we do in plastic surgery, and in my opinion patients should be selected a bit more carefully.

For example, patients on insulin pumps, those with anemia, asthma, high blood pressure with cardiac issues, or sleep apnea are a few examples of someone I would do in a hospital.  So it's an individualized decision and "one size doesn't fit all."

I happen to like my patients having an IV morphine pump they can use as needed, plus an On-Q pump to numb the area, plus pain pills for when they are ready to take food by mouth.  I like a nurse who can  monitor those meds and I don't mind my patients being a little sedated after surgery because they are being monitored.  Most of my body lift patients report pain scrores in the 3-4 range the first 2 days after surgery. This amkes me happy and I sleep better at night.

But "hospitals have higher infection rates."  True, if it is a large center with a population of chronically ill and hospitalized individuals and a large staff that circulates around touching everybody and everything. Not good.

But what if the hospital is a "surgical speciality hospital?'  There are many of those now, used by surgeons like myself who want a staff focused on our special procedures and aftercare.  No ICU, nobody from the nursing home, only 1 or 2 patients staying at a time, small staff, labs, xray, and a 24 hour doctor in house ?  Well, that would be different kind of hospital.  Here in Houston, costs are equal to or higher by about 10% compared to a surgery center.

In 2004, Florida put a 90 day ban on abdominoplasty combined with liposuction due to safety concerns.  The plastic surgery membership societies supported it.  What came next was important, because it resulted in better regulations and guidelines for patient safety:

http://www.surgery.org/media/news-releases/florida-office-su rgery-moratorium-on-combined-liposuction-abdominoplasty---po sition-of-the-american-society-

Statistics don't really matter, it is the patient sitting in front of me, who has their own medical history, their own customized surgical plan, and their own risk profile.  Basing decisoins on that is the best way to ensure paient safety in any setting.

Excellent response Dr L.  I believe most results can be good - by most plastic surgeons, but what divides the good from the EXCELLENT are those doctors who make safety a priority!  It is only when the "poo hits the fan" that you really see what a doctor is made of.  I have been an RN in many bad situations - some very sweet and kind doctors with excellent bedside manners - have acted in a not so nice or safe manner in those emergency situations.  There have been a few who have been reported for unsafe practice.  I know the OP was talking about an Outpatient vs an Inpatient facility, but I think in researching the facility - it also helps to research the surgeon's safe practice.

Thanks.  As an RN in the ICU I am sure you know all about proper monitoring and also how quickly a patient's status can change. 

I was trained by nurses at age 17-21 long before I went to med school...I was an aide, a phlebotomist, and emergency services tech.  Wore all white and answered to "orderly.!"   I learned hands-on bedside care and to this day am surprised by how that seems to be a lost art for many plastics doctors.

I LOVE JCAHO accreditation surveys !  I mean, they are such a hassle for the hospital and staff but IMO they result in the "ship being run a  little bit tighter," which benefits patients.

Anyway, it's tough for anybody non-medical to sort out safety issues regarding these procedures and facilities on their own...so professionals like you here on the boards can help. I only know of JCAHO having a database of approved facilties.  Maybe if AAAHC or AAAASF have one.  Worth a look probably.