Joan Rivers' Legacy: Heightened Attention on Outpatient Surgical Centers


In the wake of Joan Rivers' untimely death last year, ambulatory surgery centers have come under increased scrutiny. Several recent articles in the literature look at this complicated area of surgical practice.

Outpatient surgery

Surgeons might find recent publications in widely read consumer publications interesting. These articles were stimulated by comedian Joan Rivers’ Sept. 4, 2014, death at an accredited outpatient surgery clinic. Pathologists classified Rivers’ death as a therapeutic complication. According to official findings, one procedure was performed by a doctor who was not credentialed at the specific surgical center. Rivers’ vital signs deteriorated for 15 minutes before staff took appropriate actions. In addition, the medical record contained errors concerning the amount of anesthesia she received; no one had weighed her before calculating her anesthesia dose; and Rivers had not given written consent for a procedure that was performed. The clinic where Rivers was treated, Yorkville Endoscopy, will lose federal Medicare funding on Jan. 31, 2015, according to NBC News.

A Dec. 15 article in The Washington Post highlights patients’ perceptions of safety at ambulatory surgery centers (ASCs). A patient quote heightens awareness that patients sent to an outpatient surgical center may feel like they aren’t important enough to be sent to a hospital. Of further interest in this article are the many eye-opening statistics. For example, the number of ASCs has grown 41% since 2004. This article reports that in 2011, surgeons performed 23 million procedures in these facilities. It gives a good review of concerns (like the patchwork of state-level regulations covering ASC practice) and the benefits (convenience and less exposure to the busy hospital environment).

On December 18, Consumer Reports published an article on what patients should look for when selecting an ASC. Unlike the Washington Post article, this author estimates 45 million outpatient procedures are done annually at ASCs. The article suggests that patients who have any of 7 conditions (bleeding disorders, chronic lung disease, congestive heart failure, recent history of heart attack, serious arrhythmia, obesity, or uncontrolled diabetes) should avoid outpatient surgery. These conditions, also alluded to in the Washington Post article, are similar to those identified in a 2013 study conducted by researchers at the University of Michigan. That article found that patients who were overweight or obese; were subject to prolonged operative time; or had COPD, hypertension, previous PCI/cardiac surgery, and history of TIA/CVA were at elevated risk of poor outcomes. The Michigan researchers also stressed a need for improved outcomes data at ASCs.

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