Patients, physicians showed preference for in-office oculoplastics procedures
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CHICAGO — In a study aimed at verifying the safety and efficacy of in-office oral sedation for oculofacial surgeries, patients and physicians who used an ASC said postoperatively they would have preferred to be in the office.
“There are no solidified [oral sedation] protocols to the best of our knowledge that we’ve seen that really verify a way to do in-office oculoplastic surgery that’s safe for patients and providers,” Jordan R. Conger, MD, of USC Roski Eye Institute & Eyesthetica, Los Angeles, said at the ASOPRS Fall Scientific Symposium. “Our colleagues in other surgical subspecialties ... are also developing their own oral sedation techniques because in-office surgery provides cost-saving measures to the patient and the medical system at large and also is just less hoops to jump through for surgery.”
Conger and colleagues set out to determine if their oral sedation protocol was safe, effective and noninferior to performing oculoplastic surgery in an ASC. The sedation protocol included using an estimation of surgery time and the patient’s weight to determine medications and dose. An hour or less of procedural time directs the physician to use alprazolam (0.5 mg for patients 200 lb or less; 0.75 mg for those weighing more than 200 lb). If a procedure is longer than 1 hour, physicians would use lorazepam (1.5 mg for those 200 lb or less; 2 mg for those more than 200 lb) and celecoxib (200 mg).
There were no differences between the 98 patients in the in-office group and the 46 patients in the ASC group at baseline, Conger reported. Patients completed a preop survey about their anxiety, and then at the 1-week follow-up visit, patients answered a survey about their expectations of surgery and how it compared with the experience, whether they would undergo the procedure again, if they would refer a loved one, and whether they would prefer to do the procedure in the alternate location. Surgeons also answered similar questions about their overall experience, whether they would perform the procedure again in the location, and whether they would prefer to perform the procedure in the alternate location.
Responses from patients and physicians showed no significant difference except when asked if they would prefer to undergo the procedure in the opposite setting.
“More patients at the surgery center in the postop survey would rather have done it in the office,” Conger said. “When we asked the physician, ‘Would you rather have done it in the opposite setting?’, a higher percentage of the physicians at the ambulatory surgery center would have rather done it in the office.”
In breaking down the surveys by surgery type, Conger showed that these trends persisted for upper blepharoplasty, with the only difference being patients in the ASC group would prefer to do it in the office (P = .004). In the upper blepharoplasty with internal ptosis repair group, the only difference was a higher satisfaction rate from in-office patients (P = .017). There were no significant differences in the upper blepharoplasty with transconjunctival blepharoplasty group.
“Our protocol appears to be safe and effective. It is verified by both patient and physician satisfaction surveys,” Conger said. “Future data will strengthen our analysis and may aid in further stratification of surgery location based on surgery type.”
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Conger JR, et al. Oral sedation anesthesia protocol for in-office oculoplastic surgery. Presented at: ASOPRS Fall Scientific Symposium; Sept. 29-30, 2022; Chicago.
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