Over the past few decades, outpatient surgeries have skyrocketed. Performing more than 54 million surgeries each year, outpatient centers are now a major part of the American healthcare landscape. They promise convenience, lower costs, and faster recovery times. But what happens when things go wrong? This article explores the risks of outpatient surgeries and what attorneys must consider when investigating adverse outcomes from these procedures.
Outpatient, or ambulatory, surgery refers to procedures that don’t require an overnight hospital stay. First introduced in 1970 as a low-cost alternative to inpatient surgeries, these centers were designed for minor, less invasive procedures. Common examples include tendon, muscle, meniscus, and small joint repair, cataract surgery, gallbladder removal, abdominal hernia, skin therapy, lumpectomy, nerve treatments, and nose, mouth, and pharynx procedures.
The popularity of outpatient surgery surged after Medicare began paying for these procedures in 1982. But convenience came at a cost. By the mid-2010s, facility fees for these surgeries had risen by 53%, with out-of-pocket costs climbing 50%.
Though long considered safe, a joint investigation by Kaiser Health News and USA TODAY uncovered more than 260 patient deaths linked to outpatient surgeries between 2013 and 2018. And in the years following as hospitals faced COVID-19 labor shortages, many for-profit health systems doubled down on outpatient settings. Why? Because these facilities are cheaper to run. They require less staff, less infrastructure, and significantly lower overhead than hospitals.
A KFF Health News report reveals many concerning risks associated with outpatient centers, including:
- Doctors taking on risky surgeries, including on vulnerable patients
- Insufficient staff training regulations
- Limited rescue equipment on site
- Lack of proper monitoring
There are also financial incentives for physicians to recommend their own centers over hospitals. More than 75% of U.S. doctors are now employed by corporate entities, and major health systems are using outpatient care as a growth strategy. Hospital operators are pouring millions into ambulatory facilities to cut costs and boost revenue. This of course, raises concerns about profit-driven decision-making.
Who’s Most at Risk in Outpatient Settings?
While many outpatient procedures go smoothly, certain patients are at much higher risk for complications, especially during complex surgeries.
- Overweight or obesity (high BMI)
- Chronic obstructive pulmonary disease (COPD)
- Coronary artery disease or past cardiac surgical intervention
- Peripheral vascular diseases
- History of stroke or mini-stroke
- Hypertension
- Diabetes
- Female sex
- Smoking
- Prolonged operative time
While age itself isn’t a direct risk factor, many of these conditions are more common in older adults, increasing their vulnerability in outpatient settings.
Thousands of 911 calls are made from outpatient centers every year when emergencies occur. Unfortunately, help often arrives too late.
During the peak of the COVID-19 pandemic, an estimated 28.4 million surgeries were canceled or delayed worldwide. As a result, procedures like mastectomies for breast cancer, thyroid lobectomies, minimally invasive ventral hernia repairs, and parathyroidectomies were increasingly moved to outpatient centers. Further straining the system, the U.S. is projected to face a shortage of up to 30,200 surgical specialists by 2034.
Case Studies of Outpatient Surgeries Gone Wrong
When comedian Joan Rivers went in for a laryngoscopy at a New York outpatient center in 2014, no one expected her to die of cardiac arrest. The outpatient center’s staff allegedly failed to recognize her deteriorating condition in time and were left without critical expertise when one doctor departed before the procedure was finished. Rumors swirled that staff were starstruck and aimed to please Rivers, violating protocols to do so.
Her case made headlines, but it was far from isolated.
Paulina Tam, undergoing spinal surgery in California, suffocated from internal bleeding. Not knowing what to do, staff dialed 911, but it was too late.
McArthur Roberson lost over a quart of blood during spinal surgery and died on the way home. Overnight monitoring at a hospital could have saved him.
Rekhaben Shah stopped breathing during a colonoscopy. The anesthesiologist couldn’t find the right airway tube, and 33 minutes passed before paramedics intubated her, using equipment the surgery center lacked. Shah died two days later.
12-year-old Reuben Van Veldhuizen died after complications during a tonsillectomy. Staff couldn’t identify who was leading the resuscitation.
Pedro Maldonado went unresponsive post-procedure. It took staff 25 minutes to begin CPR. He died shortly after.
Sondra Wallace died hours after her sinus procedure due to an anesthesia reaction. Despite administering reversal drugs, staff discharged her without disclosing the complication, leaving her husband unaware of the danger as her condition worsened.
Abbygail Chance, age two, had known sleep apnea and arrhythmia. She turned blue en route home from an outpatient tonsillectomy and died three days later. An expert confirmed she should have been kept for inpatient monitoring.
Key Questions to Ask in Outpatient Surgery Cases
Outpatient surgery cases demand an informed review. Beyond assessing the surgeon’s performance or anesthesiology notes, you must dig deeper by asking:
- Was the patient an appropriate candidate for outpatient surgery?
- Did the facility have adequate emergency equipment and trained staff?
- Were proper protocols followed when complications arose?
- Was the choice to use an outpatient center driven by financial incentives?
- Was the patient discharged prematurely?
- Was there a delay in transferring the patient to a hospital?
In outpatient settings, there’s far less room for error. Complications can escalate quickly, and without the safety net of hospital resources, consequences can be dire.
Our highly experienced legal nurses specialize in spotting red flags in outpatient surgery cases. We provide the clinical insight needed to clarify the sequence of events, identify missed interventions, and support your legal strategy.
Contact Integrity Legal Nurse Consulting PDX to get paired with a nurse who understands the medical, legal, and ethical complexities of these high-stakes situations.
Sources:
- 10 Common Outpatient Procedures | Healthgrades
- History of ASCs | Ambulatory Surgery Center Association and ASCA Foundation
- How a push to cut costs and boost profits at surgery centers led to a trail of death | USA TODAY
- As Surgery Centers Boom, Patients Are Paying With Their Lives | KFF Health News
- The Increasing Financial Burden of Outpatient Elective Surgery for the Privately Insured | National Library of Medicine
- Physician ownership of ambulatory surgery centers and practice patterns for urological surgery: Evidence from the State of Florida | National Library of Medicine
- More than three-fourths of doctors are employed by corporations, report finds | Industry Dive
- For-profit hospital operators bet on outpatient services, expense reductions in 2023 | Industry Dive
- An analysis of risk factors and adverse events in ambulatory surgery | Dove Medical Press Ltd
- Elective surgeries during and after the COVID-19 pandemic: Case burden and physician shortage concerns | ScienceDirect
- Performance of General Surgical Procedures in Outpatient Settings Before and After Onset of the COVID-19 Pandemic | JAMA Network Open
- AAMC Report Reinforces Mounting Physician Shortage | Association of American Medical Colleges
- Settlement Reached in Joan Rivers Malpractice Case | The New York Times