Double Bay Day Surgery: Setting High Standards
More and more cosmetic procedures are being performed in day surgery centres. Sydney plastic surgeon Dr Darryl Hodgkinson talks to Anita Catalano about the safety issues of day surgery centres.
If Australia follows the lead of America as it does in most walks of life, we are in for a staggering rise in the number of outpatient surgical procedures. In the US, the number of outpatient surgery centres, or day surgery, has increased dramatically between 1989 and 1990, with office based surgery procedures increasing by 1.2 million.
It is estimated that outpatient surgery will account for more than four out of every five operative procedures performed by the year 2005, with one quarter of them being performed in a doctor’s office. But with the rise of day surgery procedures comes risks and the need for stringent controls.
The Double Bay Day Surgery is one of only a handful that is fully licensed for general and local anaesthetic.
Day surgery centres must go through a rigorous accreditation process before they can become licensed. “These guidelines allow the patient to have the security that they are in the least likely circumstances to actually get a complication, ‘’ Dr Hodgkinson said. “There’s really no other way to give the patients the security as there are no office surgery standards in Australia.’’
Sydney plastic surgeon Dr Darryl Hodgkinson, Clinical Director of the Double Bay Day Surgery, said there were a number of risks associated with surgery and one of the ways to reduce the complications was to operate in an environment that employed first class standards. “There has been a lot of media attention to problems that can occur during surgery, like infection, haemorrhage, respiratory problems and a lot of things associated with patient needs,’’ he said. “There’s really only one way of reducing the incidence of those adverse occurances and that’s by operating in the most optimal of circumstances.’’
Patients knowing the risks of antibiotic resistant staph infections during hospitalisation (recently reported in the Sydney Morning Herald) are fearful that their elective surgery may be compromised by infection if performed in an environment not dedicated to cosmetic surgery. The cosmetic surgery dedicated outpatient facility never deals with infected patients so the risks of cross infection is dramatically reduced.
Many patients are confused about the different types of anaesthesia. When choosing your surgeon, make sure you discuss what will suit you and how it will be administered. Dr Hodgkinson explains what’s available.
He said in rare cases, complications could arise as a result of anaesthesia. Dr Hodgkinson, who prefers to use general anaesthesia for larger procedures, said general anaesthesia was the most controlled because the airways were controlled and an anaesthetist helps the patient to breathe during the operation.
Day Care facilities administering general anaesthetic should be licensed by the State Board of Health. Sydney based anaesthetist Dr Howard Roby, said the government should intervene to help more day surgery centres become accredited. He believes that the licensing of such centres should take into account; the location of the surgery and ambulance access, resuscitation equipment kept on site and the continued staff education .
According to Kim Castrey, Director of Nursing at the Double Bay Day Surgery the accreditation means that the centre is under constant review by medical and health officials. “Because our day surgery is licensed as per the Department of Health guidlelines, we must provide a resuscitation trolley containing a complete set of adult resuscitation and monitoring equipment,’’ she said. “Oxygen and suction facilities are all available in appropriate locations in both our operating and recovery suite.
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“to ensure their safety, patients should ask if the day facility has gained any accreditation or licensing.”
As part of a day surgery’s licensing procedures a Medical Advisory Committee, consisting of at least five medical practitioners, oversees the clinical responsibilities and practices at the centre.
“Each and every procedure at a licensed day surgery is only to be performed by an accredited medical practitioner,’’ she said. “In the case of a procedure involving the administration of a general anaesthetic, spinal anaesthetic, epidural or major field of local anaesthetic infiltrate or IV sedation, the patient must be attended by a second appropriately accredited medical practitioner.’’
Dr Hodgkinson summed up by saying that to ensure their safety, patients should ask if the day facility has gained any accreditation or licensing.
Local anaesthetic: Local anaesthesia is similar to that which occurs in most dental offices where an injection is given around the site of surgery or into the nerves near the site, so that the nerves are non-functional for the duration of the operation. The patient has no sensation of the surgery. This is used for cases such as resection of small basal cell cancers, removal of lipomas or small lesions in the skin and occasionally for laserbrasion around the mouth or in isolated areas.
Twilight sedation: Is intravenous sedation and is administered by a specialist anaesthetist. The patient is sedated but must be able to respond verbally.
This sedation is used for smaller operations such as chemical peels, laserbrasion, otoplasty or ear surgery.
General anaesthesia: This form of anaesthesia is the most controlled of all anaesthesia. The patient is completely asleep, breathing is monitored and controlled by a specialist anaesthetist. For larger procedures, the Double Bay Surgery use general anaesthesia. Dr Hodgkinson said although there may be fears about the use of general anaesthesia, they are completely unfounded in modern day anaesthesia in healthy patients. The risk of death from general anaesthesia is 1:250,000.