Introduction
The expansion of ambulatory surgery is one of the significant achievements in modern medicine and a growing trend aimed at making medical care more accessible and convenient. The goal is to reduce hospitalization days, accelerate recovery, lower costs, and increase patient comfort.
The Rise of Outpatient Surgery in Non-Hospital Settings
Alongside these advancements, a parallel phenomenon has emerged: surgeries conducted in medical offices, makeshift clinics, and spaces attempting to function as operating rooms for seemingly simple procedures that carry real risks. For patients, it can be challenging to assess the safety of a surgical setting. Many of these locations are designed to project professionalism through decor, furniture, and layout that mimic formal installations. In other cases, despite evident deficiencies, trust in the physician and lack of knowledge create a cognitive bias that leads patients to disregard potential dangers.
Lack of Essential Support Services
Even facilities with basic infrastructure and equipment might lack specialized personnel and crucial support services such as blood banks, imaging, laboratory, and intensive care. This network of support, which enables rapid identification and management of issues to prevent minor complications from turning into tragedies, is known as rescue capacity.
Evidence of Increased Risks in Unregulated Settings
For years, it was assumed that operating in a medical office was a more efficient and cost-effective version of hospital surgery. However, evidence proves otherwise.
Influential Study on Ambulatory Surgery Safety
A groundbreaking study published in JAMA Surgery (Vila et al., 2003) revealed a concerning finding. After a Florida state mandate requiring the reporting of adverse events in all ambulatory surgical settings, researchers analyzed incidents, hospitalizations, deaths, and complications. The mortality rate in unaccredited offices was approximately 12 times higher than in regulated hospitals and ambulatory surgery centers. The difference in major complications was similar, with around 10 times more events in offices compared to hospitals.
The study concluded that medical offices, lacking structural and supervisory requirements equivalent to hospitals, had a significantly higher risk of preventable incidents and fatal outcomes. Common causes included anesthesia complications, cardiopulmonary arrest, hemorrhages, and delayed recognition of emergencies. Limited equipment, less strict protocols, and less-trained personnel were also identified as contributing factors.
Benefits and Concerns of Outpatient Surgery
Evidence supports that minor procedures, well-selected patients, and accredited spaces yield comparable results to hospitals with lower costs. The issue arises when attempting complex surgeries or high-risk patients in these environments, where severe complications significantly increase.
The “No te vamos a dormir” Argument
A common argument in these improvised surgical settings is, “We won’t put you to sleep; it’s safer, we’ll just give you a regional block.” This phrase conveys tranquility but hides complex and potentially dangerous medical realities.
Regional Blocks: Benefits and Risks
Regional blocks, whether neuraxial (epidural or spinal) or peripheral, are integral to modern anesthesia. When properly executed, they offer exceptional pain control and facilitate recovery. However, their safety depends on the clinical context, level of blockade, and the team’s ability to manage complications. Even simple blocks can produce significant systemic effects like anesthetic local toxicity, vasovagal reactions, hypotension, or respiratory issues.
Neuraxial Blocks and Increased Risk
High-level neuraxial techniques, while valid in equipped centers, are not “light” anesthesia or harmless alternatives to general anesthesia. Medical literature documents that the incidence of cardiopulmonary arrest associated with neuraxial blocks ranges approximately from 7 to 19 cases per 100,000 procedures (Lucas, et al., Anaesthesia, 2025). Though rare, it’s not infrequent enough to be ignored. When such an event occurs in an office lacking essential equipment, the chances of saving the patient plummet.
Unspoken Issues in Offering Regional Blocks
To the physiological reality, another unaddressed issue exists. In many scenarios, offering a regional block to “not put the patient to sleep” isn’t based on solid clinical criteria but rather cost reduction or compensating for the anesthesiologist’s technical limitations. The former is questionable in itself, but the latter is more serious. When an anesthesiologist lacks training, experience, or resources to intubate, ventilate, monitor, or manage anesthesia complications, they may resort to regional blocks as an apparent solution. This does not reduce risk; it amplifies it.
Call for Action and Accreditation
This is not a call to abandon ambulatory surgery. Instead, it’s an urgent appeal for medical professionals, societies, and authorities to view accreditation as the solution to a real problem and promote a care model that, when applied safely and responsibly, can significantly expand surgical options in the country.
It’s also an urgent call for patients not to fall for the allure of convenience and low cost, believing that office surgery is equivalent to hospital care. What must disappear is unaccredited, unregulated surgery in spaces lacking the necessary capacity to respond when things go wrong.
Historical Context and Modern Safety Standards
For centuries, surgery was performed in barber shops and makeshift spaces without any regulation. Discoveries like Morton’s anesthesia in 1846 and Lister’s antisepsis in 1867 marked the birth of modern surgery. Since then, we’ve known that surgery is safe only in environments capable of controlling infections, monitoring patients, and responding to emergencies. Operating in spaces lacking these capabilities is not innovation; it’s a step backward in medical safety by two centuries.
