Vocabulary
April 17, 2025
In recent years, more surgeries are being performed not in hospitals, but in medical offices. Office-based anesthesia (OBA) is fueling this shift, offering lower costs and easier scheduling. For many doctors and patients, it seems like a win-win. But behind the promise of convenience and savings lies a troubling truth: many office-based procedures are happening without the same safety checks and oversight required in hospitals or certified surgical centers.

Why More Surgeries Are Happening in Offices

Several forces are driving the trend toward office-based procedures:
  • Cost savings: Offices don't carry the overhead of hospitals, which means patients pay less, and doctors often earn more.
  • Control and flexibility: Physicians can operate on their own schedules and streamline care without hospital bureaucracy.
  • Patient demand: Minimally invasive procedures and faster recovery times have made office surgeries more appealing.
For example, cosmetic surgeries like breast augmentations and liposuction are commonly performed in office settings. It’s estimated that up to a quarter of all surgical procedures now happen outside traditional hospitals.

A Lack of Standards—and a Rising Toll

What many patients don’t realize is that while hospitals must meet strict safety standards, many offices are not held to the same requirements. That includes everything from staff training and equipment maintenance to emergency preparedness. The result? Some office procedures end in tragedy. A young woman dies from respiratory failure after a cosmetic procedure. A child has a seizure during a skin treatment and dies before emergency services can intervene. In another case, a patient develops a life-threatening reaction to anesthesia—but the life-saving drug is nowhere in sight. These stories are not rare anomalies. They’re symptoms of a larger problem: a medical environment that’s operating without rules.

What's Missing in Office-Based Anesthesia?

In a fully equipped hospital, everything from the crash cart to the oxygen tanks is routinely checked and maintained. Staff are trained to handle emergencies. Anesthesiologists are present. But in many offices:
  1. Critical equipment is outdated or missing entirely
  2. Emergency medications, like dantrolene, aren’t stocked
  3. Oxygen delivery systems may not deliver safe levels
  4. Personnel may lack anesthesia training
  5. There’s no structured post-op recovery process
Some providers even want to administer powerful drugs like propofol without a qualified anesthesia professional on site. The risks of that are immense—airway obstruction, apnea, and death are real possibilities when sedation goes wrong.

Who’s Watching?

Here’s the real kicker: in most states, no one is required to watch. Only 19 states have any rules on office-based anesthesia. And even where laws exist, enforcement is spotty. Some states rely on accreditation bodies, like the Joint Commission or AAAASF, to set and inspect standards. But accreditation is usually optional—and not all organizations agree on what’s required. Even basics, like ensuring a patient has someone to accompany them home after anesthesia, aren’t always enforced. Offices discharge patients quickly, sometimes before it's truly safe, pushing risk into the unmonitored home environment.

What Can Be Done?

Change is possible—but it takes willpower and oversight. Some steps that could make a difference:
  • State-level regulations: 
Require licensing for all offices performing procedures under deep sedation or general anesthesia.
  • Mandatory accreditation: 
All office-based surgical facilities should meet national standards, just like hospitals.
  • Uniform guidelines: 
Accreditation bodies must align on what constitutes safe practice and enforce those rules consistently.
  • Adopt proven frameworks: 
The American Society of Anesthesiologists has already published comprehensive safety guidelines, implementing them across the board could immediately raise the standard of care.

Raising the Bar Everywhere

There should not be two levels of safety, one for hospitals and another for private offices. Every patient undergoing anesthesia, no matter the location, deserves skilled providers, reliable equipment, emergency backup, and a clear path to recovery. The discipline of anesthesiology has made enormous strides in hospital-based patient safety. Extending those advances into office settings isn’t just a good idea—it’s a moral imperative. In the end, this isn’t about bureaucracy or cost. It’s about ensuring that every patient walks into a procedure knowing the system is prepared to protect them—no matter what. Source :  https://psnet.ahrq.gov/perspective/wild-west-patient-safety-office-based-anesthesia 
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