Dear Doctor,

I am contemplating surgery for a problem with one of my knees. The surgeon has recommended one of the local outpatient surgery centers. With all of the choices in town, how do I determine the best place to go? Are there questions I should ask?

RM - Billings, MT

Dear RM,

Your question is quite valid. Although patients are becoming much more savvy in evaluating their chosen health care providers, many of us forget to apply the same scrutiny to the actual places where we receive our care.

In general, most outpatient surgical facilities are extremely well run with the same or better complication rates than full service hospitals. Nonetheless, it is always good to do some homework in order to make sure that your experience is as safe and your outcome as positive as possible.

I recommend asking five key questions when choosing an outpatient surgical facility.

  1. Is the facility licensed to operate in the state of Montana?
    Most states, including Montana, require ambulatory surgery centers to undergo a rigorous licensing process in order to operate. In addition, periodic reviews are conducted by the state in order to insure quality. I would be very wary of any surgical facility that is not fully licensed to operate.
  2. What are your infection and major complication rates?
    Although this can often be a difficult number to accurately determine and a higher number in centers that perform more complex procedures does not necessarily mean a higher complication risk, it is important to make sure the center's general infection rate is not far out of proportion to similar facilities in the area.
  3. What is your transfer policy and procedure for patients who have life or limb threatening problems during or immediately after a surgical procedure?
    This is a very important question. Although most outpatient surgery centers have rigorous measures in place in order to select only those individuals best suited to outpatient surgery, adverse events happen. In the event of one of these critical events, the center must have a means for caring for the individual until they can be transported to a nearby full service hospital. This usually means a transfer agreement is in place with one or more local hospitals. I would be very concerned about having any procedure, especially one requiring general or regional anesthesia, in a facility that does not have a transfer agreement with a local full service hospital.

    In addition, I would recommend that your treating surgeon have admitting privileges at the hospital to whom you will be transferred so that they can coordinate your ongoing care.
  4. Who will provide my anesthesia? Are they licensed to practice in this state?
    Most local outpatient surgery centers utilize anesthesiologists. These are usually board certified physicians, who specialize in administering anesthetic medicine, regional anesthesia (pain blocks), and providing emergent critical care medicine if the need arises.

    Some centers use nurse anesthetists. These individuals are often well trained but they do not have the same degree of postgraduate education or scope of practice as an anesthesiologist.

    I would definitely also ask if the anesthesiologist or nurse anesthetist is certified by their licensing board and if they have a current license to practice in the state.
  5. Would you (the provider) have any concerns about having you or your family undergo surgery at this outpatient facility?
    This is self explanatory, but any hesitation or unusual body language will speak volumes.

I hope this is a helpful guide. Remember, most of the outpatient surgical facilities in this region and the country, as a whole, are very well run and provide excellent service and value for us, the consumers. There are a few “bad apples” out there, however, and it pays to do some basic homework before having any surgical procedure.

Good Luck.