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THE SAFETY OF FOOT AND ANKLE PROCEDURES AT AN AMBULATORY SURGERY CENTER

Peter Adamson

University of Texas Medical Branch


Background: There is a growing trend to perform surgical procedures at freestanding ambulatory surgical centers. There is little literature evaluating the rate of adverse events and overall safety of foot and ankle outpatient surgeries at a freestanding ambulatory surgery centers (ASC). Methods: A retrospective review of all foot and ankle cases was performed over a five year period at a single freestanding ASC. A total of 1352 cases were evaluated. Adverse events are state-reported events that cause harm or lead to additional treatment. Using adverse events criteria from previous literature involving hand and upper-extremity surgeries, we categorized our adverse events into seven categories: 1) infection requiring intravenous antibiotics or return to the operating room for irrigation and debridement, 2) postoperative transfer to a hospital, 3) wrong-site surgery, 4) retention of a foreign object, 5) postoperative symptomatic thromboembolism (DVT), 6) medication error, and 7) bleeding complications. Results: The overall rate of adverse events was 2.3% with 31 events identified over the five year period. There were a total of 23 infections, 5 symptomatic thromboembolism, and 3 post-operative transfers to a hospital. There were no medication errors, bleeding complications, wrong-site procedures, or retained foreign bodies during our study period. Conclusion: Outpatient foot and ankle procedures are not without complications, but the rate of adverse events post-operatively is low (2.3%). Overall, foot and ankle surgeries can be performed safely in an outpatient setting at an ASC.

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