ARLINGTON HEIGHTS, Ill. - Recommended steps to ensure that appropriate patients are selected for plastic surgery in the office setting were detailed in the second of four "practice advisories," published in Plastic and Reconstructive Surgery®, the official medical journal of the American Society of Plastic Surgeons (ASPS). "Two of the most important steps doctors can take to ensure appropriate patient selection in office-based surgery are to give the patient a complete preoperative physical exam and evaluate the patient's medical history," said Ronald Iverson, MD, chair of the ASPS Task Force on Patient Safety in Office-based Surgery Facilities and co-author of the advisory. "Doing so helps the doctor determine the most appropriate time and facility setting for the patient and gives the medical staff helpful information to better interpret findings while monitoring the patient during and after surgery."
Practice Advisory Recommendations:
Review Preoperative History and Perform Physical Examination - To determine a patient's medical history, the doctor should review a patient's personal health, social and family history, body systems, medication regimen, and allergies. The doctor should determine the availability of a responsible adult to care for the patient after surgery.
A thorough physical exam is essential to assess the patient's clinical status before the procedure and should include a determination of the patient's general health and appearance; measurement of height and weight; assessment of vital signs, including the heart and lungs; and a detailed exam of the anatomical area where the surgery will be performed.
During this review, doctors should identify conditions that may predispose the patient to intraoperative and postoperative complications. According to the advisory, particular attention should be given to age, weight and history of other illnesses, including diabetes, cardiac diseases and respiratory conditions.
Conduct Preoperative Tests - The advisory recommends doctors order tests to completely assess a patient's preoperative health, depending on the results of a patient's preoperative medical history and physical exam. Tests may include electrocardiograms for patients over 45 years old or at any age when known cardiac conditions exist, and complete blood count/blood chemistries for such specific diagnoses as anemia, diabetes, hypertension and diuretic therapy. Additional tests may be appropriate, depending upon the specific procedure being performed.
Determine Appropriate Facility Location - Doctors ultimately are responsible for selecting the appropriate facility for each patient and should use the American Society of Anesthesiologists (ASA) Physical Classification Ratings to help determine the right facility for their patient. Their analysis should be based on the preoperative medical history and physical examination, laboratory results and the medical specialist's evaluation. According to the practice advisory, a normal, healthy patient or a patient with mild health conditions is the best candidate for office-based surgery. Patients with more severe health problems, as defined by the ASA ratings, may be reasonable candidates for office-based surgery when the mode of anesthesia is tailored to the individual patient's condition and the facility is accredited.
Meet Provider and Surgical Facility Standards - As with any plastic surgery procedure, the doctor, regardless of the location of the surgical facility, should have hospital privileges for the procedure and be qualified for examination or be certified by a surgical board recognized by the American Board of Medical Specialties (ABMS), such as the American Board of Plastic Surgery (ABPS).
"By completing a thorough preoperative medical history and physical examination, and following the facility selection recommendations, doctors can help to ensure a safe and positive experience for the patient," said Dr. Iverson.
As of July 1, 2002, the ASPS requires all members who perform surgery under anesthesia to do so in an accredited, licensed or Medicare-approved facility.
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