Accreditation, Board Certification, State Regulation: Elements in Safe Office Based Surgery

Patient safety in surgery has long been important in the lengthy education and training of surgeons. Plastic surgeons typically have 4 years of medical school, 5 years of general surgical residency and additional years of plastic surgical residency or fellowship. The American Society of Plastic Surgeons is a national organization that emphasizes patient safety in many ways. One of them is the requirement for ongoing specific patient-safety education, another is the requirement that member surgeons only operate in accredited surgical facilities.

ACCREDITATION is the process which recognizes that the facility meets detailed standards. The process is similar to that for hospitals and out-patient surgical centers, but tailored to the size and scope of the office facilities. The process includes complying with standards (architectural, equipment, staffing training, reporting, etc.). Our center is accredited by the American Association for Accreditation of Ambulatory Surgery Facilities, Inc. (AAAASF.org). JCAHO, AOA and AAAHC are other similar organizations. As of 2007 South Carolina state law requires accreditation by one of these national organizations.

BOARD CERTIFICATION is a voluntary process of evaluating a physician's education and training. Members of the American Society of Plastic Surgeons and the American Society for Aesthetic Plastic Surgery are required to maintain board certification. Dr. Graham achieved board certification in plastic surgery in 1992. He exceeds continuing medical education standards in his specialty. Patients treated in our office surgical facility have the additional benefit of a board certified MD anesthesiologist for their procedures.

STATE REGULATION has been encouraged by the American Society of Plastic Surgeons, as they believe patient safety will be enhanced. The South Carolina State Board of Medical Examiners put in place state regulations several years ago, but these were strengthened when full accreditation was required for all medical offices providing general anesthesia or deep sedation (level II & III facilities). Regulations are contained in statue Chapter 81-96. Additional regulations are produced by DHEC.

Cosmetic Surgery Safety: California requires pre-op medical clearance ("Donda West Law")

Dr. Graham has emphasized safety and patient comfort for almost 20 years performing cosmetic surgery. Our patients receive thorough medical history evaluation and perioperative teaching, appropriate physical examination, and evaluation of our physician anesthesiologist prior to surgery. We contact our patient's primary care doctors, and occasionally cardiologists, to request relevant health information prior to surgery. This is nothing new.

Following an unfortunate well publicized tragedy in California, a local legislator held a public contest to request suggestions for laws. As a result her law requires a preoperative medical evaluation by a physician before cosmetic surgery.

Excerpt: "Governor Arnold Schwarzenegger signed into law on Oct. 11 legislation authored by District 62 Assemblymember Wilmer Amina Carter that would requires a health check and a written clearance before being allowed to undergo plastic surgery. Assembly Bill 1116, named the Donda West Law, was inspired by the death of Kanye West's mother. The bill came as a result of her 62nd Districtwide contest, "It Ought to Be a Law." "This law will potentially saved lives," Assemblymember Carter said. "There is a growing trend of people opting to have elected cosmetic surgery, and they are not aware of the risks involved." Specially, the law requires physicians and surgeons, including people licensed by the state holding permits to perform elective facial cosmetic surgery to complete a physical examination including a complete medical history on their patients, prior to performing elective cosmetic surgery"

For the complete article see: http://democrats.assembly.ca.gov/members/a62/newsroom/20091014AD62PR02.htm

The text of Assembly Bill 1116 follows:

http://info.sen.ca.gov/pub/09-10/bill/asm/ab_1101-1150/ab_1116_cfa_20090504_131942_asm_comm.html

Accreditation standards for Office Surgical Facilities and hospitals routinely require pre-operative medical history taking and physical examination. All surgeons that are members of the American Society of Plastic Surgeons (http://www.plasticsurgery.org/) are required to only operate in accredited facilities. For more information on our quality and safety see our website, http://www.expertplasticsurgeon.com/html/about.html#nationally-accredited-facilities

Safe Surgery in the News

Recently the Wall Street Journal ran an article stressing the importance of safety and accreditation in office-based surgery (including cosmetic surgery). (July 21, 2009) We couldn't agree more.

The article highlights that many facilities lack oversight, regulation, etc. Potential patients should be aware that the American Society of Plastic Surgeons saw the importance of facility accreditation several years ago. The ASPS requires that all of its members only operate in accredited facilities. Members are also board-certified in plastic surgery.

Our office surgical facility was carefully designed from the outset with safety in mind. It has been nationally accredited from the beginning by the American Association for Accreditation of Ambulatory Surgery Facilities (AAAASF). This includes annual review, on-site visits, staff training and certification, back-up equipment and safety systems. Our facility meets or exceeds state laws and regulations. All anesthesia is performed by our board-certified MD anesthesiologist. All OR nursing and physician personnel are Advanced Cardiac Life Support certified (ACLS). http://www.expertplasticsurgeon.com/html/about.html#nationally-accredited-facilities

http://online.wsj.com/article/SB10001424052970203946904574300971306299860.html

Diprivan (Propofol) in Plastic Surgery: Safe usage vs. Michael Jackson in the news

Safety in surgery and anesthesia are extremely important to us at the Aesthetic Center. We have a nationally accredited in-office surgery facility with all anesthesia provided by our board-certified physician (MD) anesthesiologist. This facility and its staff is unique in the Carolina upstate. http://www.expertplasticsurgeon.com/html/about.html#nationally-accredited-facilities

The news about the death of performer Michael Jackson has included mention of Propofol (diprivan) a potent sedative normally used in anesthesia, being used for insomnia treatment by a home care physician. We do not want adverse news or mis-information about this medication to cause concern among our patients or the public. For those that want more information, we suggest a website rxlist.com. http://www.rxlist.com/diprivan-drug.htm

It's FDA approved uses are induction and maintenance of general anesthesia or monitored anesthesia care, and sedation of intensive care unit patients on breathing machines. The usage in our facility is according to FDA approved guidelines and accepted standards of anesthesia professional care.

Office Plastic Surgery & Anesthesia Safety

The safety of both anesthesia care and surgical procedures has improved greatly in the past 25 years. The number and complexity of out-patient surgery across all surgical specialties has increased several fold. All surgery involves risks, but risk reduction is accomplished in many ways.

In 2007, according to the American Society of Aesthetic Plastic Surgeons, 54% of all cosmetic procedures were performed in office surgical centers, and another 28% in out-patient surgical centers. That leaves only 17% having been done in hospitals. Surgical procedure statistics showed 8% increase from the prior year. (http://www.surgery.org/)

National accreditation is one important assessment of the dedication and quality of a office surgical facility. The American Association for Accreditation of Ambulatory Surgical Facilities evaluates our facility(http://www.aaasf.org/). We undergo annual assessment requiring 100% compliance, including periodic inspection. The criteria are numerous, but include preoperative medical screening, availability of emergency equipment and medications, and advanced life support certification. These address some of the questions raised by recent media & public concern over safety issues in Florida, California, and NYC.

We offer full-time board-certified physician anesthesiologist care, in addition to our board-certified plastic surgeon. All our anesthesia is personally done by the anesthesia doctor. Dr. Graham concentrates on your surgery and is not responsible for also supervising a nurse anesthetist. Safety is an attribute of our practice. For other ways in which our practice is different, read our new website.

Update July 16, 2008. See the link http://www.plasticsurgery.org/media/press_releases/July08-PRS-PatientSafety.cfm