In a recent blog posted on Healio.com, Daniel Durrie, M.D., chairman of the board for iOR Partners, addresses safety. Coincidentally, the number one question surgeons ask when it comes to office-based surgery (OBS): Is OBS safe? Previously, cataract surgery transitioned from the hospital to the ASC in the ‘80s, the same concerns over safety existed. Now, we don’t think twice about the safety standards of an ASC. Soon, we may not give a second thought about the safety of OBS. Dr. Durrie addresses top safety concerns in his blog on office-based cataract surgery.
Does office-based cataract surgery take place in a procedure room?
No, it is a common misperception that OBS is done in a clean room or a procedure room. Office-based surgery is any surgical or invasive procedure performed by a licensed physician in an operating room within the physician’s practice. The Joint Commission, Accreditation Association for Ambulatory Health Care (AAAHC), and the American Association of Accreditation of Ambulatory Surgery Facilities (AAAASF) are all accrediting institutions. These institutions are the same that accredit ASCs.
What type of ophthalmic procedures are common in OBS?
Common ophthalmic OBS procedures include basic cataract surgery, refractive cataract surgery, refractive lens exchange, ICL, various oculoplastics, MIGs and other lens-based procedures.
What are the clinical outcomes of OBS cataract surgery?
Office-based surgery provides safe and effective outcomes that are comparable to those performed in an ASC. Kaiser Permanente conducted The largest U.S. retrospective study. The study (Office-Based Cataract Surgery: Population Health Outcomes Study) researched 21,501 cataract surgeries. They found that OBS efficacy outcomes were consistently excellent, with a safety profile expected of minimally invasive cataract procedures performed in ASCs and HOPDs. In over 5000 procedures performed in iOR facilities, our safety profile is consistently as good or better as those in the Kaiser study.
Type of Anesthesia Used
Ophthalmic OBS can utilize either Class A (oral and topical) or Class B (I.V. sedation). A large portion of OBS cases are performed under Class A level anesthesia. They don’t require any additional patient monitoring or staff.
What about patients with comorbidities?
Comorbidities are assessed on a case-by-case basis. Surgeons can take patients with comorbidities to the ASC. However, the surgeons we work with at iOR Partners become more comfortable overtime with bringing these patients to the OBS. The ASV is a viable backup for cases of a significant comorbidity. These would require additional equipment or anesthesia team.
Additionally, an ophthalmologist’s office can better control the patient flow for social distancing. Additionally, minimizing the exposure between patient and staff in the era of COVID. The bottom line is that each transition to a new setting is disruptive and raises concerns over safety. Office-based surgery is gaining momentum as the new standard of care for cataract surgery. The ophthalmic community recognizes that OBS facilities adhere to the highest safety standards and protocols.