Back Home by Sundown
"If I were having a simple, straightforward procedure, I probably wouldn't go to a hospital," says O'Leary. "But I wouldn't go to a doctor's office either."Surgery centers, he notes, are more tightly supervised than doctors' offices and don't harbor as many free-floating germs as hospitals. But if the procedure were complicated or if he had an underlying health problem, he'd opt for a hospital.
Hospitals may have an edge when it comes to quality control. "A patient who comes into a hospital for surgery can have a high level of confidence that the operating room and doctors and nurses involved are working under a set of standards and regulations that ensures at least a reasonable degree of safety," says Robert Wachter, chief of the medical service at the University of California-San Francisco Medical Center and coauthor of Internal Bleeding: The Truth Behind America's Terrifying Epidemic of Medical Mistakes. Hospitals aren't immune: Wachter and coauthor Kaveh Shojania found victims of error at hospitals and clinics around the country, from the transplant patient whose donor's blood type didn't match to the woman whose surgeon left a crowbar-size instrument in her abdomen. But the farther a patient migrates from the hospital setting, says Wachter, the less stringently regulated the setting will be.
Reined in. Indeed, until a few years ago, surgery centers were the Wild West of medical care: largely unregulated and unaccredited. Now that states are tightening up (14 so far require that outpatient facilities be accredited), about three quarters of surgery centers are accredited by JCAHO, the Accreditation Association for Ambulatory Health Care, or the American Association for Accreditation of Ambulatory Surgery Facilities. A stamp of approval from one of the three, while not a guarantee of excellence, says that the center has at least met certain basic industry standards for safety and quality, Wachter says. "The best analogy might be the health department inspection of a restaurant. Passing doesn't say the food is terrific, just that the place is clean and safe." In a 2005 report, the AAAHC found that nearly all outpatient surgery centers now have systems in place to prevent infection and wrong-site surgery and to check for drug allergies.
Next, the spotlight is moving to doctors' offices, home to an increasing number of tummy tucks, cataract operations, biopsies, and other procedures. Last year, an estimated 10 million surgeries were performed in doctors' offices, twice as many as in 1995, according to the American Society of Anesthesiologists. Some states do impose standards, but strictness varies considerably. Wachter, for one, worries about a lack of resuscitation equipment such as cardiac defibrillators and high-flow oxygen--and the know-how to use it. In a 2003 study of outpatient surgeries in Florida, researchers found that the incidence of death and injury, while still low, was 10 times higher when surgery was performed in an office compared with outpatient surgery centers. Wachter advises asking: "What happens if I stop breathing? What happens if my heart stops? What equipment and procedures are in place in case of an emergency? What if I need to go to a hospital?" He says, "You want to know if they've ever done that before or do they say, 'That's never happened to us; we cross our fingers and call 911.'"
Don't forget, too, to disclose any risks you bring to the operating table. For anyone whose body is stressed by other health problems, a top-ranked hospital might be the best choice of all.
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