Is outpatient surgery safe?

The death of Joan Rivers last fall after a common procedure to examine her digestive tract has sparked concern about outpatient surgical centers. Would the comedian be alive today if she had been treated in a hospital? That's difficult to say. But it's clear that doctors are doing more outpatient procedures—some of them complicated—and not always on the appropriate patients. So it's important to make sure that you're a good candidate before your surgery is scheduled, and to know what to look for in a facility.

The number of outpatient procedures done each year has tripled in the past three decades to about 54 million. And because of shorter-acting anesthesia and less invasive surgery, people are now going to those facilities for everything from biopsies and knee surgery to mastectomies. Among the most common procedures are cataract surgery, colonoscopy, and endoscopy, the procedure Rivers reportedly had. Many centers are privately owned by physicians; others are affiliated with hospitals, sometimes even located on hospital grounds.

There have been some well-publicized problems, such as a hepatitis C outbreak in 2007 that was traced to a Las Vegas endoscopy clinic. But infections actually appear to be less likely in outpatient surgery centers than in hospitals, says Claudia Steiner, M.D., a senior physician researcher at the Agency for Healthcare Research and Quality. That's in part because people undergoing outpatient surgery are usually healthier than hospitalized patients.

Check our hospital Ratings to see how hospitals in your area compare on safety. And use our advice to choose the right doctor.

Though outpatient surgery in general seems safe, some procedures are riskier than others. For example, Steiner's research found that just one out of 1,000 people undergoing a common outpatient procedure to treat an enlarged prostate gland developed a surgical-site infection within 14 days. By comparison, six times as many people who had an abdominal hysterectomy or hernia repair developed infections during that time frame.

Your risk also depends on your anesthesia. For deep sedation, or general anesthesia, an anesthesiologist who's a physician (not a nurse) should always oversee your care, says Consumer Reports medical adviser Orly Avitzur, M.D.

It's challenging to find information about specific centers. Unlike hospitals, most out­patient surgery centers aren't required to report infections or other complications, and they aren't inspected by a single organization. That makes it difficult for consumers to compare facilities. Lisa McGiffert, director of the Consumer Reports Safe Patient Project, says more oversight is needed. "Private accreditors are paid to evaluate," McGiffert says. "And states have different licensing requirements."

Even a simple procedure in a good center can be a bad idea if you have a serious health problem. In that case, "you face a much higher risk of complications and would be better off in a hospital, which can respond to emergencies," says Consumer Reports' chief medical adviser, Marvin M. Lipman, M.D. Be leery of outpatient procedures if you have a history of:

• A bleeding disorder
• Chronic lung disease
• Congestive heart failure
• A heart attack within the past four to six months
• Serious arrhythmia
• Serious weight problems
• Uncontrolled diabetes

1. Is it accredited?

Check for Medicare certification or accreditation from the Joint Commission, the Accreditation Association for Ambulatory Health Care, the American Association for Accreditation of Ambulatory Surgery Facilities, or the Healthcare Facilities Accreditation Program.

2. Who owns it?

Outpatient centers can be a profitable business, so many doctors have invested in them. But that raises ethical concerns because they might have a vested interest in doing more procedures. And just because a doctor owns a facility doesn't mean it's the best place for you. So be wary if you are referred to one that's owned by your doctor.

3. Who is the anesthesiologist?

If you need general anesthesia, make sure you're under the care of someone who is board-certified.

4. How much experience does the doctor have?

Look for someone who has performed your procedure at least 50 times in the past year.

5. What's the emergency plan?

Ask whether there's resuscitative equipment on site and whether your doctor is certified in advanced resuscitation techniques in case something goes wrong.

6. How close is a hospital?

Your doctor should have admitting privileges at a nearby hospital in case there is an emergency.

7. What's the infection rate?

Ask how many patients have to be hospitalized because of infections after your procedure. Your doctor should be able and willing to share that information. "The goal should be zero," says Consumer Reports' Lisa McGiffert.

8. What should I do before I'm discharged?

Get the name and number of a nurse or doctor to call if you have a problem. Also ask about signs and symptoms to watch for.

Prices for the same procedure in the same community can vary widely among ambulatory centers, so it pays to shop around. That's especially true if you have insurance with a high co-payment or deductible. Shown here are price ranges that insurers in the Chicago area pay for two common outpatient procedures.