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Not too long ago, nearly all but the simplest procedures and surgeries were done in hospitals. But with the emergence of newer technologies and medical advancements, outpatient surgeries became common. Now, many procedures can be done in free-standing ambulatory surgery centers (ASC) or in office based operating rooms (OBOR) which are not located in hospital buildings. 

But which procedures should be done in a traditional hospital setting and which can be done in an ASC or OBOR? This depends on the procedure and a patient’s overall health. For shorter procedures, typically less than 3 to 5 hours, a non-hospital setting may be appropriate. This includes plastic surgery procedures such as:

  • Breast augmentations, reductions & lifts
  • Tummy tucks & body lifts
  • Liposuction
  • Face lifts & brow lifts
  • Eyelid procedures
  • Arm lifts & thigh lifts
  • Nose & ear reshaping

The other consideration for non-hospital based surgery is a patient’s health and any medical conditions that may affect surgery. Generally, healthy patients or those with only mild medical problems are good candidates for surgery at an ASC or OBOR. The decision as to where to have surgery is typically made by the surgeon and the anesthesiologist beforehand to ensure the best care for each individual patient. 

The advantages of having a procedure at an ASC or OBOR include a lower cost and more convenience for a patient. Also, these facilities tend to use shorter acting anesthesia and sedation techniques that allow for faster recovery and less nausea and discomfort after surgery. In facilities that focus on only certain specialties or procedures, a well trained team can provide more standardized and efficient care that cannot be duplicated in large medical centers which must deal with a wide range of specialists and procedures.

When considering a procedure in a non-hospital setting, make sure the following issues are addressed to your satisfaction:

Is the facility accredited? All plastic surgeons who are members of the American Society of Plastic Surgeons (ASPS) must perform surgery in accredited facilities. Most commonly, their OBOR facilities are accredited by the American Association for Accreditation of Ambulatory Surgery Facilities, Inc. (AAAASF) which is considered the “Gold Standard” for plastic surgery facilities. (To find a list of ASPS member surgeons, go to the Find a Surgeon Site.) Other accreditation agencies include the Accreditation Association for Ambulatory Health Care (Accreditation Association or AAAHC) and The Joint Commission.

Is there a transfer policy? In the unlikely event of a problem, an accredited facility will have an arrangement with a local hospital to transfer a patient for further care.

Is the surgeon credentialed to do the procedure at a local hospital? Since there is no oversight as to what any doctor can do in an OBOR and in some ASCs, there are non-surgeons have been performing procedures at these facilities that they would not be credentialed, or allowed, to do at a hospital. If your surgeon is not Board Certified buy the American Board of Plastic Surgery, you should ask to see proof that the surgeon is credentialed to perform the same procedure in a local hospital. For a listing of Board Certified plastic surgeons, go to the Is Your Surgeon Certified? site. (For more information, go to White Coat Deception – Who is Really a Plastic Surgeon?)

The decision to have surgery at an ASC or OBOR should be based on a patient’s medical condition and the type of procedure being done. The anesthesiologist’s input will also be considered to ensure a high level of safety. For properly selected patients, surgery in an ASC or OBOR has a very high safety record and tends to have better patient satisfaction compared to surgery done at a hospital. 

“Having served on the Medical Boards of two certified ambulatory surgery centers, and on the American Society of Plastic Surgeon’s Patient Safety Committee, I appreciate the importance of being able to offer safe and efficient procedures in an ASC and OBOR for properly selected patients. Like most other Board Certified plastic surgeons, I am able to offer my patients a procedure in a traditional hospital setting, an ambulatory surgery center (ASC) or in an office-based operating room (OBOR) depending on their individual needs and expectations.”

Karol A. Gutowski, M.D.

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