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Study indicates hand, upper-extremity surgery may be safely performed in outpatient setting
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Investigators of a study recently published in The Journal of Bone and Joint Surgery found a low adverse event rate after hand or upper extremity surgeries performed at a freestanding ambulatory surgery center, which they note demonstrates that these surgeries can be completed safety in an outpatient setting.
“Our study shows that with proper patient selection, hand and upper extremity surgery can be completed safety at a freestanding ambulatory surgery center,” study coauthor Kanu S. Goyal, MD, said in a press release from the American Academy of Orthopaedic Surgeons.
Goyal and colleagues retrospectively reviewed 28,737 cases of hand and upper extremity surgeries performed at a single, freestanding ambulatory surgery center during an 11-year period. Investigators defined adverse events as serious complications that harmed patients or led to further treatment. Adverse events were divided into seven groups based on state-reportable adverse event criteria, including infection needing IV antibiotics or return to the OR, postoperative transfer to a hospital, symptomatic thromboembolism, a wrong-site procedure, retention of a foreign object, a medication error or bleeding. Investigators then determined whether these adverse events required additional laboratory testing, hospital admission, return to the OR, emergency department visits, or physical or mental disability.
Results showed 58 reported adverse events, with a 0.20% rate overall. Fourteen patients had major infections, with 11 of these patients requiring a return to the OR and three patients needed IV antibiotics. There were also 21 patients who needed to be admitted to the hospital after being discharged and one medication error.
According to researchers, there were four cases of postoperative hematomas. Investigators noted there were no deaths, no wrong-site procedures or retained foreign bodies. ‒ by Monica Jaramillo
References:
Goyal KS, et al. J Bone Joint Surg Am. 2016;doi:10.2106/JBJS.15.00239.
Disclosures: The researchers report no relevant financial disclosures.
Perspective
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— Scott H. Kozin, MD
Advances in medicine have allowed surgeons to perform procedures in outpatient surgery centers that were once reserved exclusively for hospital ORs. As the number of surgeries performed on an outpatient basis continues to grow, it becomes important that we continue to examine and to monitor the safety of outpatient surgical procedures. Outpatient surgery centers tend to focus on a select patient population that is relatively healthy. In this paper, upper extremity surgical procedures predominate the surgeries performed with a smattering of other surgical procedures, such as ophthalmologic; urologic; ear, nose and throat; foot and ankle; and pain management surgical procedures
In their large series of 28,737 cases performed during an 11-year time span, adverse events were defined as serious complications causing harm to a patient or leading to further treatment. Adverse events were divided into seven categories: infection requiring intravenous antibiotics or return to the OR; postoperative transfer to a hospital; wrong-site surgical procedure; retention of a foreign object; postoperative, symptomatic thromboembolism; medication error; and bleeding complications. There were only 58 reported adverse events with an overall rate of 0.20%. There were no deaths. There were 14 infections, 18 postoperative transfers to a hospital, 21 hospital admissions after discharge, one medication error, and four postoperative hematomas.
There were no cases of wrong-site surgical procedures which as attributed to the attending physician always marking the surgical incision site with the patient awake, surgical checklists and strict time-outs that allowed all members of the operative team to agree on the procedure and surgical site before incision.
The authors further attribute their low adverse events to five consistent hand and upper extremity surgeons operating at the facility during the time period studied, the use of checklists, a low turnover rate among the OR staff and familiarity with the surgical routines of the surgeons.
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