Some surgeries and procedures are considered “minor” when compared with lengthy, invasive operations such as heart or brain surgery…or a hip or knee replacement.
The so-called simple procedures—performed about 40 million times each year in the US—often take place in ambulatory surgery centers (ASCs), where you’re sent home in a few hours. But what happens when simple surgeries go wrong—or even turn deadly?
NOT SO SIMPLE AFTER ALL
Since their introduction in the US in the 1970s, ASCs have been a valuable resource, helping patients avoid hospital-acquired infections and speeding recovery at home in more comfortable surroundings.
However, the risks are real. Deaths resulting from treatment at ASCs are not officially tracked, but according to a recent investigative report published by USA Today Network and Kaiser Health News, more than 260 ASC patients died from surgical complications (such as internal bleeding and cardiac arrest) over the last five years. Some key risks—and how to protect yourself…
• Cosmetic surgery (such as a face-lift). What can go wrong: Particularly during any type of cosmetic surgery, in which a surgeon is operating near the mouth, nose, vocal cords or neck, general anesthesia (the use of a drug to make the patient unresponsive and unconscious) or “deep sedation” (similar to general anesthesia but often does not involve a breathing tube) can interfere with a patient’s ability to breathe.
To protect yourself: If your surgeon plans to use deep sedation, ask whether a dedicated sedation provider will be involved (by law, general anesthesia requires an anesthesiologist, nurse-anesthetist and/or anesthesiologist assistant). Or ask whether the surgeon can use local anesthesia or a nerve block instead. With a nerve block, local anesthetic is injected near nerves and specific body parts that will be affected by the surgery. Nerve blocks have different risks from general anesthesia and deep sedation but usually don’t impede your ability to breathe or your level of consciousness.
• Tonsillectomy. Nearly 300,000 tonsil-removal surgeries are performed each year in adults—often prompted by frequent sore throats. But chronically swollen tonsils also contribute to sleep apnea, which raises risks for serious conditions, such as heart attack and stroke.
What can go wrong: Tonsillectomy involves the airway and blood vessels. Persistent bleeding in the airway after tonsillectomy is an infrequent but serious complication that requires immediate attention and can arise hours after the procedure…long after the ASC closes.
To protect yourself: Ask to be the first case of the day. This is the best time to schedule any procedure—but especially this one. Scheduling early in the day gives the most time for any complication to be addressed on-site.
• Bunionectomy. What can go wrong: Recovery from bunion removal can be very painful, and opioid pain relievers often are prescribed for the immediate post-op period and beyond. This can be dangerous, especially for patients with sleep apnea, obesity or advanced age. In addition to depressed breathing, opioids can trigger a variety of side effects, including nausea/vomiting and urinary dysfunction.
To protect yourself: Before your procedure, discuss the plan for post-op pain management. Ask your doctor how you can limit opioid use by instead relying on alternatives, including nonsteroidal anti-inflammatory drugs (NSAIDs) and the COX-2 inhibitor celecoxib (Celebrex). These drugs target enzymes responsible for inflammation and pain without such a high risk for side effects.
• Endoscopy. What can go wrong: With endoscopy, which involves the use of deep sedation, both the doctor performing the procedure and the anesthesia provider are working inside your airway. This means that contents from your stomach could get into your lungs (aspiration).
To protect yourself: Make sure you are a suitable candidate and without an acute illness (see below).
ARE YOU AN ASC CANDIDATE?
If you’re elderly and/or have chronic health problems that increase your risk for complications during or after your surgery—such as moderate-to-severe sleep apnea, morbid obesity or chronic obstructive pulmonary disease (COPD), discuss with your primary care doctor and the doctor performing the procedure whether you’re a suitable candidate for outpatient surgery at an ASC.
Also, if you have a cold, the flu or a fever, call to notify your outpatient facility—you may be asked to reschedule the procedure to a time when you are well. Similarly, if your blood sugar or blood pressure is high or unstable…or you have shortness of breath from asthma or heart failure, notify the doctor performing the procedure and get advice on the best plan of action.
OTHER SAFEGUARDS YOU NEED
Before undergoing treatment at an ASC, also make sure that…
•The facility only rarely needs to transfer a patient to a hospital for more advanced care. The hospital also should be relatively close.
•There will be electronic monitors and “crash carts” on-site.
•A dedicated anesthesiologist, nurse-anesthetist or anesthesiologist assistant will be on hand during the procedure. This is crucial if you will be receiving general anesthesia or deep sedation. Deep sedation carries greater risks than “conscious sedation,” during which the patient is able to respond to verbal prompts and commands. Note: If you are comfortable with taking oral medication for anxiety and prefer not to take the additional risks associated with deep sedation, ask for conscious sedation, and make sure your consent form indicates this.
•Your oxygen saturation and exhaled carbon dioxide (“capnography”) will be continuously monitored by the dedicated provider mentioned above during all procedures requiring deep sedation or general anesthesia. Oxygen saturation also should be monitored continuously during recovery from deep sedation or general anesthesia. The recovery area should be staffed by a qualified professional trained in basic and advanced cardio life support.
•The doctor performing the procedure has board certification by a board that is a member of the American Board of Medical Specialties, ABMS.org. This credential is highly recommended and offers an added layer of safety.