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In the wake of a surprising death, is outpatient surgery safe? An expert says yes.

TAMPA — It may be months before it's known for sure why a seemingly healthy 49-year-old St. Petersburg man died Friday after going to a surgery center for a simple hernia repair procedure. But a local expert says the case should not lead anyone to conclude that it is not safe to have surgery in an outpatient facility rather than a hospital, as Spiro Gogas did.

Gogas, an amateur bodybuilder who did not drink or smoke, was co-owner of the popular Athenian Garden restaurants. On Friday morning, he went to Carillon Surgery Center in St. Petersburg for a hernia operation. By 11 a.m., his family had been told that his heart had stopped while he was under anesthesia. Doctors at Northside Hospital, where he was transported from Carillon, were unable to save him.

The Pinellas-Pasco County Medical Examiner's Office is awaiting test results and does not expect to determine a cause of death before 60 to 90 days.

Dr. Hector Vila, an assistant professor of anesthesiology at Moffitt Cancer Center in Tampa, has studied extensively the safety of surgeries that are performed outside of hospitals. A leader in a national group that accredits outpatient surgical centers, Vila was not involved in Gogas' care.

Generally, he said Wednesday, you're much more likely to survive surgery in an outpatient surgery center than you are driving a car.

"It's very safe," said Vila, "One of the safest activities you can engage in."

How do surgery centers compare to hospitals for safety?

Studies show the chance of dying in an outpatient surgery center is one in a million. It approaches the safety of flying with a major airline. Statistically, it's safer than having surgery in a hospital because (hospitals are) where the sicker people go who have more complicated medical conditions. Also, in an outpatient center you aren't exposed to many of the serious infections that are present in hospitals.

How well-equipped are outpatient centers to handle an emergency?

You have the same basic safety equipment you would find in a hospital — the equipment necessary to perform an immediate cardiac resuscitation and rescue from medical complications. What you don't have is the more technologically advanced machines for cardiac bypass and ventilators to help with breathing, what we think of as high-tech, intensive care equipment. It would be rare to need that in a resuscitation.

What could go wrong that would require advanced emergency medical care beyond the scope of a surgery center?

Heart attack, stroke, an allergic reaction to medication or anesthesia that the patient didn't know about. There is a rare genetic disease, an allergy to commonly used anesthesia, called malignant hyperthermia. Families usually know about it because someone has had it in the past. It is life-threatening wherever it happens but surgery centers should have the antidote. In my 20 years in practice, I've seen it once.

What questions should patients ask when choosing a surgery center?

• Make sure the facility is accredited by one of three agencies: the Joint Commission; the American Association for Accreditation of Ambulatory Surgery Facilities (the group that Vila is affiliated with); or the Accreditation Association for Ambulatory Health Care.

• Talk with the surgical staff about what will happen if there is an emergency, so you know what plan is in place if something goes wrong.

• Make sure you talk with the surgeon or the anesthesiologist before the day of your procedure about your medical history, so everyone is aware of other medical conditions you may have.

• Be sure to discuss drug allergies and medications.

More questions

In addition to asking about accreditation, the nonprofit Institute for Safety in Office-Based Surgery has these recommendations for anyone considering an outpatient surgery or a procedure in a physician's office:

• Ask whether the physician has privileges at a local hospital. That means your doctor has been reviewed by his or her peers.

• Ask whether your physician is board certified, has undergone voluntary peer review in a medical specialty.

• Ask who will administer the anesthesia. If general anesthesia will be used a board certified anesthesiologist is best; for lower levels of sedation a registered nurse anesthetist may be used.

In the wake of a surprising death, is outpatient surgery safe? An expert says yes. 12/14/11 [Last modified: Wednesday, December 14, 2011 10:27pm]
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