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首页> 外文期刊>Dermatologic surgery >Office surgery incidents: what seven years of Florida data show us.
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Office surgery incidents: what seven years of Florida data show us.

机译：办公室手术事件：佛罗里达州的七年数据向我们展示了什么。

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BACKGROUND: In the wake of increased media attention focusing on human error in medicine, numerous state medical boards and legislatures have drafted, and are continuing to draft, regulations aimed at protecting patients undergoing procedures in the office setting. These regulations will have a considerable impact on patient access to medically necessary procedures, and any regulations should be based on good data. This report summarizes 7 years of prospective data from the state of Florida, the best data available on office surgery incidents. OBJECTIVE: The objective was to determine the nature and incidence of hospital transfers and deaths resulting from office procedures. METHODS: This study is a compilation of mandatory reporting by Florida physicians to a central agency of all in-office adverse incidents resulting in death, serious injury, or hospital transfer in the State of Florida from March 2000 to March 2007. Telephone and internet follow-up was conducted to determine reporting physician board certification, hospital privileges, and office accreditation. RESULTS: In 7 years there were 31 deaths and 143 procedure-related complications and hospital transfers. Liposuction and liposuction with abdominoplasty or another cosmetic procedure resulted in 24 complications and 8 deaths. Of the offices reporting adverse incidents, 38.5% were accredited by an independent accrediting agency, 92.5% of the physicians were board-certified, and 96.6% had hospital privileges. A total of 58% (18/31) of the deaths and 61% (87/143) of the complications were associated with nonmedically necessary (cosmetic) procedures. A total of 78% (14/18) of these deaths were in ASA Class 1 patients. Plastic surgeons were responsible for 48% of all deaths (83% of cosmetic surgery deaths) and for 52% of all hospital transfers (83% of cosmetic surgery complications and hospital transfers). CONCLUSION: Plastic surgeons were responsible for an inordinate number of deaths and hospital transfers. Requiring physician board certification and physician hospital privileges would not seem to increase safety, because most physicians already have these credentials, and physicians without these credentials were not responsible for a disproportionate share of incidents. These data do not show an emergent hazard to patients from medically necessary office surgery. Liposuction under general anesthesia deserves continued scrutiny because deaths due to this procedure continue to occur and this procedure can be performed with dilute local anesthesia, with which no deaths were reported. Mandatory reporting of office incidents should be strongly supported, as well as reporting of incidents that occur after surgery in the hospital outpatient department and ambulatory surgery center. These data should be available for analysis after protecting patient confidentiality. A national debate needs to occur to determine how many deaths and injuries are acceptable from cosmetic procedures performed under general and intravenous anesthesia.
机译：背景：随着越来越多的媒体关注医学上的人为失误，许多州医疗委员会和立法机关已经起草并正在起草旨在保护患者在办公室进行手术的法规。这些法规将对患者获得必要的医疗程序产生重大影响，任何法规都应基于良好的数据。本报告总结了佛罗里达州7年的前瞻性数据，这是有关办公室手术事件的最佳数据。目的：目的是确定因办公室程序而导致的医院转移和死亡的性质和发生率。方法：本研究是佛罗里达州医生向中央机构强制性报告的摘要，该报告涉及2000年3月至2007年3月在佛罗里达州导致死亡，严重伤害或医院转移的所有办公室内不良事件。进行了评估，以确定报告的医师委员会认证，医院特权和办公室认证。结果：在7年中，有31例死亡和143例与手术相关的并发症和医院转移。吸脂和吸脂配合腹部整形术或其他美容手术导致24例并发症和8例死亡。在报告不良事件的办公室中，有38.5％得到了独立认证机构的认可，有92.5％的医生获得了董事会认证，有96.6％的患者享有医院特权。总计58％（18/31）的死亡和61％（87/143）的并发症与非医学上必要的（美容）程序有关。这些死亡总数中有78％（14/18）是ASA 1类患者。整形外科医生占所有死亡人数的48％（占整容手术死亡人数的83％）和所有医院转移的52％（占整容手术并发症和医院转移人数的83％）。结论：整形外科医生负责过多的死亡和医院转移。要求医师委员会认证和医师医院特权似乎并不会增加安全性，因为大多数医师已经拥有这些凭据，而没有这些凭据的医师也不应对过多的事件负责。这些数据并未显示由于医学上必要的办公室手术对患者的紧急危害。全身麻醉下的抽脂术应继续进行检查，因为该手术导致的死亡继续发生，并且该手术可以在稀薄局部麻醉下进行，没有死亡报道。应大力支持强制性报告办公室事件，以及报告医院门诊部和门诊手术中心在手术后发生的事件。在保护患者的机密性之后，这些数据应可用于分析。需要进行全国性辩论以确定在全身麻醉和静脉麻醉下进行的整容手术可以接受多少例死亡和受伤。

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