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Among the many important decisions involved in aesthetic and reconstructive surgery, deciding where the operation will take place ranks right up there with who you’ll trust to do it. In recent years, many plastic surgeons have been following the trend and choosing to operate out of accredited rooms in their own offices. Many patients prefer the privacy; however, this Charlotte’s Book reader is wondering if it’s better to be in the safety of a hospital.
“I am thinking of getting some plastic surgery, and some doctors have private operating rooms and others do not. What are the pros/cons and is it safer to be in a hospital? What if something goes wrong?”
Much-loved aesthetic and reconstructive surgery expert Dr. Sophie Bartsich, MD, FACS, responds:
“Plastic surgeons are unique in that many, if not most of them, operate in their own offices in private operating rooms. Private operating rooms offer many advantages, both financially and socially, but as with anything else in beauty and life, there are also potential problems and pitfalls.
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There are three types of operating rooms: private offices, outpatient surgical centers, and hospital-based operating suites. Hospital-based operating rooms are part of an existing hospital, and many different types of surgical procedures are performed in the different rooms. In addition to surgeons, the suites are staffed by teams of nurses and anesthesiologists, and in cases where the hospital is located at an academic center, there are also resident surgeons-in-training available to assist. Scheduling a surgery at a hospital is subject to availability, and the surgeon usually cannot choose his or her own support staff among the crowd. More importantly, because most of the other surgical patients are not there to receive cosmetic surgery, many of them are quite sick, and some are riddled with infections which can spread to others.
HOSPITAL BASED OPERATING SUITES
Overall, the hospital setting can appear unfavorable to the average breast augmentation patient, a young and healthy woman who only needs two hours of surgical time in the cleanest facility possible. In the rare case that she suffers a terrible complication, then she is in the safest place she could be. A hospital setting means that you are surrounded by people who are prepared to care for sick patients and handle emergencies swiftly. If you need to stay overnight for nausea or pain control, there are inpatient units to which you can be admitted. And God forbid you need an intensive care unit, there is one a few floors down. In sum, it is very unusual to need a full hospital after routine cosmetic surgery, but if you need one, it is optimal that it be right there for you.
On the other end of the spectrum is the private office surgery center. These facilities are monitored and credentialed carefully, and periodically evaluated to ensure that they are up to strict standards. That being said, they are privately run, which means that there is a lot of variability depending on the surgeon and his or her resources. Benefits to this setting include ease of scheduling (sometimes including weekends at the surgeon’s discretion) much lower operating costs, and a hand-picked staff that will work on your case. If needed, there is also the benefit of discretion, and a generally more intimate and personalized setting.
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That being said, if you do run into a problem, the staff will have to call 911 and wait for an ambulance to arrive and take you to the nearest hospital. You will still have the on-site team to help you, but no other help will be there until you are transported to a higher care facility. This is one reason why, although exceedingly rare, serious complications occurring in private facilities often end very badly.
OUTPATIENT SURGERY CENTERS
The third and “middle ground” approach to surgical suites is the outpatient surgery center. These are free-standing establishments that have multiple operating rooms and specialize in same-day procedures. They offer the benefit of relatively easy scheduling, mostly healthy patients with lower rates of severe infections, and personalized staff that is well versed in same-day procedures. Schedules do not usually get as backed up as in hospitals, and most of the centers are more pleasant to visit and offer more personalized care. If you run into real trouble here, you would still need to be transported to the hospital via emergency vehicle, but there would be many more people available to help you on site, and the trip would generally be more efficient and streamlined. You would not have the same “backdoor” effect on privacy as in a private office, but most outpatient centers can accommodate the need for discretion.
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Choosing where to have your surgery performed is a personal and important decision. If you are considering a private office setting, be prepared to ask the questions that matter, such as “What hospital do you work with?” and “Are all of your staff trained to properly handle emergencies?” And if the answer is “I don’t work with any hospitals because I have never needed them,” buyer beware. Properly credentialed surgeons should be affiliated with at least one major medical center, and ideally should have an academic appointment. They should be trained and equipped to handle an emergency situation. Anyone who claims that they never have a complication is either misrepresenting themselves or not operating enough. In the right hands, a private office can be a lovely place to have your surgery, but not all are created equal.”