Health Affairs, 22, no. 2 (2003): 283-284 doi: 10.1377/hlthaff.22.2.283-a © 2003 by Project HOPE	New Online   Obama's Success & Next Steps   3 Health Policy Options for President Obama   A Hybrid Proposal   Bipartisan Compromise

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Letters

Liposuction Can Be Safe In Offices

Data from six years of 911 emergency calls in Seattle show that cardiac arrests in offices are very rare, except for dialysis centers and cardiologists’ offices.¹ The same study also points out that the public is much more likely to have a cardiac arrest at an airport, gymnasium, or golf course than in a doctor’s office. Most of us are aware that multiple forms of anesthesia are used in dental offices, including inhalation of nitrous oxide, apparently with little danger.

The authors also call for a "pressing need for states to address the safety of office facilities and to ensure that only qualified providers perform these procedures." Excellent prospective data from Florida are reassuring in this regard.² The Florida data show the following: In 2001 and 2002 there were no injuries or deaths from liposuction by dermatologists, who use dilute local anesthesia (so-called tumescent anesthesia); there were no incidents or deaths due to the anesthesia when using conscious sedation; 98 percent of all physicians reporting incidents had hospital privileges and were board certified; anesthesiologists or nurse anesthetists provided all general and deep sedation; and no physicians performed procedures outside their scope of specialty training.

Considering the verifiable data that are available, state medical boards and legislatures should consider evidence-based regulations that restrict or eliminate liposuction under general anesthesia until further study shows why so many deaths and injuries are associated with this procedure; require defibrillator placement in dialysis centers and cardiologists’ offices; mandate the placement of drugs to reverse anaphylactic reactions; and require that incident reports be made publicly available to all parties to use in devising further regulations and strategies.

Brett Coldiron

American Society for Dermatologic Surgery, Rolling Meadows, Illinois

NOTES

1. L. Becker et al., "Cardiac Arrest in Medical and Dental Practices," Archives of Internal Medicine 161, no. 12 (2001): 1509–1512.[Abstract/Free Full Text]
2. B. Coldiron, "Patient Injuries from Surgical Procedures Performed in Medical Offices," Journal of the American Medical Association 285, no. 20 (2001): 2,582; and B. Coldiron, "Office Surgical Incidents: Nineteen Months of Florida Data," Dermatological Surgery 28, no. 8 (2002): 710–712.

When we first approached the subject of medical error in the outpatient setting, reliable data on the phenomenon—not to mention attention to the problem—were sparse. It is reassuring to learn of some of the new data that Brett Coldiron reports, particularly the prospective data from Florida. Nevertheless, data on the incidence and causes of adverse events in the outpatient setting remain a mere trickle, while unsupported assertions, untested assumptions, and unsubstantiated claims continue to flood the policy literature and the popular press.

We reiterate our contention that policy should not be formulated in a vacuum, and we concur that the evidence base about errors in the outpatient setting—both why mistakes happen and how best to prevent them—needs shoring up. To that end, we welcome further research and attention to the problem, particularly at the state level.

Elizabeth M. Armstrong and Elizabeth M. Lapetina

Princeton University, Princeton, New Jersey
Lewin Group, Falls Church, Virginia

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