OK – You’ve decided to have cosmetic surgery, but should you have it done at a hospital or in a private surgical facility? For most patients the answer will depend on where the plastic surgeon you’ve chosen operates. I personally choose to operate in an outpatient surgical center that is part of my office, but is it as safe as a hospital? Here are some thoughts for your consideration:

• Everyone who works in or who is a subcontractor for our surgicenter must sign a confidentiality agreement in which they promise to keep strictly confidential all matters pertaining to the patients for whom they care. To fail to do so may result in termination of their employment. This commitment to confidentiality allows for peace of mind, especially in cases where the leakage of such information could be highly damaging to the patient.

• In the matter of sterility, both hospitals and private surgical facilities must meet and maintain strict standards so as to minimize the risk of infection. Face it, though, hospitals care for much sicker patients! Superbugs such as MRSA are found much more frequently at hospitals because the patients are treated with much stronger antibiotics that allows for the emergence of these highly antibiotic–resistant strains of bacteria. If you are having cosmetic surgery patient at such a facility, you’re going to be exposed to such bacteria.

Furthermore, your surgery case is more likely to follow a case that involves an infected patient when you have surgery at a hospital than in a private surgical facility. Hospitals care for many sick patients. Even though the operating rooms are carefully cleaned between cases, it’s difficult to eliminate every potential source of infection. What about an employee who may not be as careful as they should be when it comes to changing their scrub clothes after an infected procedure and could cross-contaminate the next patient? In my surgical facility we rarely operate upon infected patients and when we do, the infected case is always scheduled at the end of the day.

• The personnel who work in a private surgical facility are employed because of their ability to offer superior care to cosmetic surgery patients. The nurses are experts in plastic surgical techniques and know the equipment inside and out. Our anesthesia providers offer a type of of anesthesia that is lighter and more patient friendly than the type that is given at a hospital. It’s not that the anesthesiologists at the hospital can’t do that type of anesthesia; it’s just that many cases at the hospital require a heavier type of anesthesia that is more likely to result in nausea and a groggier patient afterwards. When that’s the type of anesthesia that’s usually done, it may be difficult to shift gears when something lighter is desired.

• The plastic surgeon has control over which supplies and equipment are used in a private surgical facility as opposed to the hospital where such decisions are made by a committee. A more expensive suture or a more expensive medication that would not be available or allowed at a hospital can be used in the private facility if it allows superior care. We have used Zofran as an anti-nausea drug for years at our surgicenter. In the past when I would go to the hospital to do a case, Zofran was difficult to obtain for most patients because of its higher cost than the less effective medications.

• Private surgical facilities are less expensive than hospitals. Although many factors contribute to this cost difference, the bottom line is that you can have the same operation for a fraction of the cost in the private facility.

What are some disadvantages to a private surgical facility?

• If you are a patient with significant medical problems, your surgery would probably be best done at a hospital. Despite the fact that our surgery center has emergency equipment and protocols in place to deal with common problems, a high risk individual would nonetheless be better served at a hospital. The more pressing question might be, “If your health is not very good, should you even be considering cosmetic surgery?”

• If insurance is covering a portion of your procedure, the surgery center may not a provider for the insurance company and it may be to your financial advantage to do the surgery at a hospital that participates in the insurance plan. Many private surgery centers, though, are also contracted with insurance companies, so check with you doctor or the insurance company.

Should you have any further questions, please contact my office.

George Sanders, M. D