Where’s The Best Place To Have Cosmetic Surgery? A Hospital? A Doctor’s Office?

Photograph of an operating room There are a lot of terrific plastic surgeons in Fort Worth and the North Texas area.  Each surgeon chooses where to do surgery.  Different types of surgical facilities exist, so I thought I’d take a few minutes to discuss pros and cons of each.

What is an accredited surgical facility?

An accredited surgical facility is one that meets established standards for quality and safety.  Accredited surgical facilities in Fort Worth must be licensed by the State of Texas.  The State has its own standards that must be reached before a facility may open.  Accreditation typically requires a facility to:

  • Allow surgery to be performed only by a board-certified or board-eligible surgeon
  • Maintain a staff of certified nurses and surgical technicians who are trained in managing cardiac and respiratory distress
  • Provide anesthesia by a board-certified or board-eligible anesthesiologist or certified nurse anesthetist (cRNA)
  • Adhere to local, state, and national regulations including fire safety, sanitation, and building codes
  • Adhere to federal laws and Occupational Safety and Health Administration (OSHA) regulations
  • Monitor patients during surgery and immediate recovery to ensure safety

A number of accrediting organizations exist.  The biggest and probably most widely recognized is the Joint Commission on Accreditation of Health Care Organizations (JCAHO).  This is the “heavyweight” of organizations, responsible for overseeing hospitals and most major surgery centers.  Other organizations exist too.  They tend to regulate smaller surgical facilities, like those in a doctor’s office.  If your plastic surgeon does surgery in her or his office, it’s worth making sure that their office facility is accredited.  One of the largest organizations providing accreditation for office operating rooms is the American Association for Accreditation of Ambulatory Surgery Facilities (AAAASF).  If your surgeon does not have accreditation by an organization like this, that should be a major “red flag”.  I know I would personally NOT undergo major surgery in a facility without this type of accreditation.

Where is surgery performed?

It depends on the type of surgery being done, and the surgeon.  We’ll focus on cosmetic plastic surgery.

Photograph of members of the operating room team Cosmetic surgery in a Fort Worth hospital

A lot of plastic surgeons don’t like to work in bigger hospitals.  Hospitals can be big places.  They typically have layers of administration, lots of rules and regulations, many employees, and the surgeons often have little to no control over any of those things.  Hospitals are sometimes a bit inconvenient for patients undergoing cosmetic surgery.  They may have to check in on one floor, go to another area to be evaluated by nurses, and then moved to a different floor to have their surgery.

I personally LOVE doing surgery in hospitals.  I do this almost every day, particularly for my “bigger” cases.  The layers of administration mean that there is a LOT of oversight regarding who works there and how things get done.  There are substantial protocols regarding safety, sanitization, and staffing.  Before a surgeon can do surgery in a hospital, a credentialing committee  reviews a large packet of information on the physician.  This includes schools attended, training completed, and recommendations by peers. The same applies to anesthesiologists.

I do longer cases in bigger hospitals.  Combination cases like mommy makeovers often take 5 to 7 hours to complete.  I like patients to spend the night after that length of case.  Hospitals are well-equipped for that.  Andrews Women’s’ Hospital at Baylor Scott & White, and Texas Health Southwest Fort Worth hospital are the two hospitals I use most for longer cases.

Plastic surgery in an ambulatory outpatient surgery center

Ambulatory surgery centers (ASC’s) are great.  They provide many of the same services as the larger hospitals.  ASC’s are much smaller than hospitals.  They’re more convenient for patients.  The surgery centers also must be licensed by the state and accredited by a governing body like JCAHO.  I do ‘smaller’ and shorter cases at ASC’s, Medical Center Surgery Center Fort Worth, and Texas Health Surgery Center Fort Worth Midtown.  For instance, if I’m doing cases that take 1 – 3 hours, like breast augmentation or cosmetic eyelid surgery, I usually use one of these facilities.  If a case is likely to take longer than 4 – 5 hours, I prefer to do them in a hospital.

Cosmetic surgery in a surgeon’s office

This can also be a very good option.  I, like the majority of doctors, can do minor procedures in my Fort Worth office.  For instance, I fix torn earlobes and do minor scar revisions under local anesthesia in my office.  We are not equipped to do surgery that requires deeper anesthesia.  Some plastic surgeons do have operating rooms inside their offices.  They have the equipment and the staffing to do cases that require either general anesthesia (being put to sleep) or twilight anesthesia (intravenous sedation).  In most of those settings, a certified nurse anesthetist (cRNA) provides the anesthesia.  The surgeon is responsible for oversight of the cRNA.  In some situations there may be a physician anesthesiologist providing the anesthesia.

If your surgeon wants to do surgery in her or his office, that’s probably terrific.  But, it’s worth making sure about the level of accreditation of the office operating room.  There may be some doctors out there who will do larger procedures in their office, but haven’t undergone all of the scrutiny of governing bodies (like JCAHO) to obtain accreditation.  If that’s the case,  credentialing oversight could be less stringent than at ASC’s and hospitals.   Operating room nurses and anesthesia providers may rotate between that office and three or four others, potentially increasing inconsistencies in delivery of care.  Sanitization protocols could be less vigorously reviewed.   If your surgeon cannot provide accreditation credentials, that should be a major ‘red flag‘.  While these types of issues are rarely a problem, it’s worth finding out before your surgery in an office operating room what accreditation the facility has.

Where should you have plastic surgery in North Texas?

I take comfort in doing surgery where all of the nurses, doctors, and ancillary staff have been fully vetted.  I like the idea of facilities having to pass inspection every couple of years.  When choosing a plastic surgeon, do your homework.  Understand that where your surgery is done matters.

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