office-based surgery

Is OBS Safe? Top 5 Questions Answered on the Safety of Office-Based Cataract Surgery

In a recent blog posted on Healio.com, Daniel Durrie, M.D., chairman of the board for iOR Partners, addresses the number one question surgeons ask when it comes to office-based surgery (OBS): Is OBS safe?  When 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. Below are the top safety concerns Dr. Durrie addressed in his blog regarding 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. OBS utilizes the same standard of care as an ASC or hospital and is accredited by the same national organizations including The Joint Commission, Accreditation Association for Ambulatory Health Care (AAAHC), or the American Association of Accreditation of Ambulatory Surgery Facilities (AAAASF).

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. The largest U.S. retrospective study (Office-Based Cataract Surgery: Population Health Outcomes Study) of 21,501 cataract surgeries conducted at Kaiser Permanente Colorado 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.

What type of anesthesia is used?

Ophthalmic OBS can utilize either Class A (oral and topical) or Class B (I.V. sedation). Most OBS cases are performed under Class A level anesthesia and don’t require any additional patient monitoring or staff.

What about patients with comorbidities?

Comorbidities can be 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. In the case of a significant comorbidity where additional equipment or anesthesia team is needed, then the ASC is a viable backup.

In addition to the points above, an ophthalmologist’s office can better control the patient flow for social distancing and minimize 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 as the ophthalmic community recognizes that OBS facilities adhere to the highest safety standards and protocols.

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